Provider Demographics
NPI:1699948323
Name:NORWOOD, LASSITER AND ASSOCIATES
Entity type:Organization
Organization Name:NORWOOD, LASSITER AND ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-474-3152
Mailing Address - Street 1:PO BOX 859
Mailing Address - Street 2:311 SOUTH MAIN STREET
Mailing Address - City:NORWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:28128
Mailing Address - Country:US
Mailing Address - Phone:704-474-3152
Mailing Address - Fax:704-474-0274
Practice Address - Street 1:311 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NC
Practice Address - Zip Code:28128
Practice Address - Country:US
Practice Address - Phone:704-474-3152
Practice Address - Fax:704-474-0274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995126Medicaid
NC8996468Medicaid