Healthcare Provider Details

I. General information

NPI: 1376878058
Provider Name (Legal Business Name): MAYE LAZAAR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 CAHALAN AVE
SAN JOSE CA
95123-3010
US

IV. Provider business mailing address

5710 CAHALAN AVE
SAN JOSE CA
95123-3010
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 Number50482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: