MEDICARE: DR. TADEO SINGSON LAZO DENTIST

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	1223G0001X	General Practice Dentistry	32467	NY

General Provider Information

NPI Number	:	1639154719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TADEO SINGSON LAZO DENTIST

Provider Business Mailing Address
First Line	:	33 S MAIN ST
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-4914
Country	:	US
Telephone Number	:	845-356-0788
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 S MAIN ST
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-4914
Country	:	US
Telephone Number	:	845-356-0788
Fax Number	:

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

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	07/08/2007

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