Provider Demographics
NPI:1770372427
Name:DANTZLER, LETASHA D
Entity type:Individual
Prefix:
First Name:LETASHA
Middle Name:D
Last Name:DANTZLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9037 BILLY PAT DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-6844
Mailing Address - Country:US
Mailing Address - Phone:901-846-2272
Mailing Address - Fax:
Practice Address - Street 1:9037 BILLY PAT DR
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-6844
Practice Address - Country:US
Practice Address - Phone:901-846-2272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)