Healthcare Provider Details

I. General information

NPI: 1154438125
Provider Name (Legal Business Name): BENVA LAZAR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 CAHALAN AVE SUITE 9
SAN JOSE CA
95123
US

IV. Provider business mailing address

5710 CAHALAN AVE SUITE 9
SAN JOSE CA
95123
US

V. Phone/Fax

Practice location:
  • Phone: 408-224-4155
  • Fax: 408-578-5518
Mailing address:
  • Phone: 408-224-4155
  • Fax: 408-578-5518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: