Provider Demographics
NPI:1285008979
Name:LASSITER, TERRY (DDS)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:LASSITER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SUN VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3571
Mailing Address - Country:US
Mailing Address - Phone:254-666-1366
Mailing Address - Fax:
Practice Address - Street 1:211 SUN VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3571
Practice Address - Country:US
Practice Address - Phone:254-666-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist