Healthcare Provider Details

I. General information

NPI: 1700070372
Provider Name (Legal Business Name): KEYVAN KEVIN LAZAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KEVIN LAZAR DDS

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 E PALMDALE BLVD SUITE # E
PALMDALE CA
93550-4557
US

IV. Provider business mailing address

247 EAST PALMDALE BLVD SUITE # E
PALMDALE CA
93550
US

V. Phone/Fax

Practice location:
  • Phone: 661-265-9400
  • Fax:
Mailing address:
  • Phone: 661-265-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number47382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: