Provider Demographics
NPI:1851433536
Name:LASORSA, MATTHEW J (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:LASORSA
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 1:2460 N ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-5321
Mailing Address - Country:US
Mailing Address - Phone:352-527-1614
Mailing Address - Fax:352-527-1985
Practice Address - Street 1:2460 N ESSEX AVE
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-5321
Practice Address - Country:US
Practice Address - Phone:352-527-1614
Practice Address - Fax:352-527-1985
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00149781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice