Provider Demographics
NPI:1598740425
Name:LANTIN, DANTE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANTE
Middle Name:
Last Name:LANTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6106
Mailing Address - Country:US
Mailing Address - Phone:617-770-0349
Mailing Address - Fax:
Practice Address - Street 1:250 MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-3120
Practice Address - Country:US
Practice Address - Phone:617-288-1140
Practice Address - Fax:617-288-3910
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA141101Medicaid
MAH43948Medicare UPIN
MA141101Medicaid