Provider Demographics
NPI:1861470544
Name:LASSITER, BRIAN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
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 1:705 W LA VETA AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4402
Mailing Address - Country:US
Mailing Address - Phone:714-997-2735
Mailing Address - Fax:714-997-9022
Practice Address - Street 1:705 W LA VETA AVE
Practice Address - Street 2:STE 202
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4402
Practice Address - Country:US
Practice Address - Phone:714-997-2735
Practice Address - Fax:714-997-9022
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist