Provider Demographics
NPI:1508304650
Name:MONROE DENTAL CLINIC GENERAL PARTNERSHIP
Entity Type:Organization
Organization Name:MONROE DENTAL CLINIC GENERAL PARTNERSHIP
Other - Org Name:NORWOOD DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-292-1642
Mailing Address - Street 1:102 E WINDSOR STREET
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112
Mailing Address - Country:US
Mailing Address - Phone:704-292-1642
Mailing Address - Fax:704-225-8291
Practice Address - Street 1:102 E WINDSOR STREET
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112
Practice Address - Country:US
Practice Address - Phone:704-292-1642
Practice Address - Fax:704-225-8291
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LASSITER & ASSOCIATES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty