Provider Demographics
NPI:1285197830
Name:LASSEN DENTAL LLC
Entity Type:Organization
Organization Name:LASSEN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFFEN
Authorized Official - Middle Name:NIELS
Authorized Official - Last Name:LASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-419-6156
Mailing Address - Street 1:4120 QUEST DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-8768
Mailing Address - Country:US
Mailing Address - Phone:541-688-7278
Mailing Address - Fax:541-334-6604
Practice Address - Street 1:4120 QUEST DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-8768
Practice Address - Country:US
Practice Address - Phone:541-688-7278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1965981OtherCIGNA
OR3771529OtherPACIFIC SOURCE
OR500757214Medicaid
OR004179098OtherUNITED CONCORDIA
ORP00001209592OtherODS
OR1750811485OtherREGENCE