Provider Demographics
NPI:1457542417
Name:LASSETTER, JEREMY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:LASSETTER
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 1:5 PALISADES DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-6433
Mailing Address - Country:US
Mailing Address - Phone:518-348-0634
Mailing Address - Fax:518-426-3221
Practice Address - Street 1:5 PALISADES DR
Practice Address - Street 2:SUITE 210
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-6433
Practice Address - Country:US
Practice Address - Phone:518-348-0634
Practice Address - Fax:518-426-3221
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8682122300000X
NY0559741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist