Provider Demographics
NPI:1003625120
Name:LASITER, CHEYENNE R (RDH)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:R
Last Name:LASITER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-3063
Mailing Address - Country:US
Mailing Address - Phone:918-219-4873
Mailing Address - Fax:
Practice Address - Street 1:805 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-1224
Practice Address - Country:US
Practice Address - Phone:417-262-6070
Practice Address - Fax:417-262-6071
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist