Healthcare Provider Details

I. General information

NPI: 1043451735
Provider Name (Legal Business Name): SHANNON H. LAZARIAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6269 CHARONOAK PL
SAN GABRIEL CA
91775
US

IV. Provider business mailing address

14445 OLIVE VIEW DR
SYLMAR CA
91342-1437
US

V. Phone/Fax

Practice location:
  • Phone: 266-318-2928
  • Fax:
Mailing address:
  • Phone: 818-364-4350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58611
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: