Healthcare Provider Details

I. General information

NPI: 1225975543
Provider Name (Legal Business Name): RAFAEL DE OLIVEIRA LAZARIN DMD, MS, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DRIVE DEPARTMENT OF PERIODONTOLOGY
GAINESVILLE FL
32611
US

IV. Provider business mailing address

714, SW 16TH AVE APT 306
GAINESVILLE FL
32601
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8360
  • Fax:
Mailing address:
  • Phone: 352-219-5334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDTP874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: