MEDICARE: STEVE LAZAR DMD, P.C. DBA ADVANCED DENTISTRY

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	261QD0000X	Dental Clinic/Center	4414	NV

General Provider Information

NPI Number	:	1912277096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVE LAZAR DMD, P.C. DBA ADVANCED DENTISTRY

Provider Business Mailing Address
First Line	:	5731 S FORT APACHE RD
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5666
Country	:	US
Telephone Number	:	702-476-2700
Fax Number	:	702-476-2730

Provider Business Practice Location Address
First Line	:	5731 SOUTH FORT APACHE RD
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5666
Country	:	US
Telephone Number	:	702-476-2700
Fax Number	:	702-476-2730

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVE LAZAR
Credential	:	DMD
Telephone Number	:	702-476-2700

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	01/06/2012

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