Provider Demographics
NPI:1801541438
Name:CIRCE LASSEGUE DDS, PLLC
Entity type:Organization
Organization Name:CIRCE LASSEGUE DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CIRCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSEGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-793-9219
Mailing Address - Street 1:21820 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-1235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21820 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-1235
Practice Address - Country:US
Practice Address - Phone:305-793-9219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental