MEDICARE: DR. ROBERT M LAZERSON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0106X	Oral and Maxillofacial Pathology Dentistry	008132	GA

General Provider Information

NPI Number	:	1235248170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT M LAZERSON D.D.S.

Provider Business Mailing Address
First Line	:	3020 ROSWELL RD
Second Line	:	SUITE 110
City	:	MARIETTA
State	:	GA
Zip	:	30062-4996
Country	:	US
Telephone Number	:	770-565-8730
Fax Number	:	770-509-2323

Provider Business Practice Location Address
First Line	:	3020 ROSWELL RD
Second Line	:	SUITE 110
City	:	MARIETTA
State	:	GA
Zip	:	30062-4996
Country	:	US
Telephone Number	:	770-565-8730
Fax Number	:	770-509-2323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	02/22/2026

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