MEDICARE: DR. STEVEN R LAZAR D.M.D.

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	12224	MA

General Provider Information

NPI Number	:	1740277631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN R LAZAR D.M.D.

Provider Business Mailing Address
First Line	:	211 COLLEGE RD
Second Line	:
City	:	CONCORD
State	:	MA
Zip	:	01742-1526
Country	:	US
Telephone Number	:	978-369-2314
Fax Number	:	781-899-1531

Provider Business Practice Location Address
First Line	:	25 LIONEL AVE
Second Line	:	SUITE A
City	:	WALTHAM
State	:	MA
Zip	:	02452-4864
Country	:	US
Telephone Number	:	781-899-1157
Fax Number	:	781-899-1531

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	07/08/2007

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