Provider Demographics
NPI:1932294121
Name:LASAPONARA, JAMES R (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:LASAPONARA
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 1:267 PEARL ST
Mailing Address - Street 2:UNIT #B-3
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8564
Mailing Address - Country:US
Mailing Address - Phone:802-864-1927
Mailing Address - Fax:
Practice Address - Street 1:617 RIVERSIDE AVENUE
Practice Address - Street 2:THE DENTAL CENTER AT CHCB
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1601
Practice Address - Country:US
Practice Address - Phone:802-652-1050
Practice Address - Fax:802-652-1056
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0160001135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1611863Medicaid
VT0160001135OtherSTATE LICENSE