Provider Demographics
NPI:1235360595
Name:LASANTA-GARCIA, REINALDO (DMD)
Entity Type:Individual
Prefix:DR
First Name:REINALDO
Middle Name:
Last Name:LASANTA-GARCIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 SHANNON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3771
Mailing Address - Country:US
Mailing Address - Phone:919-493-1402
Mailing Address - Fax:919-403-2392
Practice Address - Street 1:3622 SHANNON RD STE 101
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3771
Practice Address - Country:US
Practice Address - Phone:919-493-1402
Practice Address - Fax:919-403-2392
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL018001733122300000X
IL019.0281641223G0001X
FLDN224261223G0001X
NC90821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist