Healthcare Provider Details

I. General information

NPI: 1861757460
Provider Name (Legal Business Name): ADAM MINEAR LAZAR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 01/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E COLONIAL DR
ORLANDO FL
32801-1206
US

IV. Provider business mailing address

304 E COLONIAL DR
ORLANDO FL
32801-1206
US

V. Phone/Fax

Practice location:
  • Phone: 407-841-7321
  • Fax:
Mailing address:
  • Phone: 407-921-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19831
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: