Healthcare Provider Details

I. General information

NPI: 1346298650
Provider Name (Legal Business Name): MICHAEL PAUL LAZARSKI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W WARNER RD SUITE 7
CHANDLER AZ
85224-2758
US

IV. Provider business mailing address

1200 W WARNER RD SUITE 7
CHANDLER AZ
85224-2758
US

V. Phone/Fax

Practice location:
  • Phone: 480-899-0770
  • Fax: 480-505-6425
Mailing address:
  • Phone: 480-899-0770
  • Fax: 480-505-6425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5186
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: