Healthcare Provider Details

I. General information

NPI: 1497002075
Provider Name (Legal Business Name): DARIENE V LAZORE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 W HAPPY VALLEY RD STE B103-104
GLENDALE AZ
85310-2608
US

IV. Provider business mailing address

6615 W HAPPY VALLEY RD STE B103-104
GLENDALE AZ
85310-2608
US

V. Phone/Fax

Practice location:
  • Phone: 623-267-9367
  • Fax:
Mailing address:
  • Phone: 232-678-0886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD008523
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: