Healthcare Provider Details

I. General information

NPI: 1447694799
Provider Name (Legal Business Name): LAZCANO FAMILY DENTAL P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10051 PINES BLVD STE C
PEMBROKE PINES FL
33024-6172
US

IV. Provider business mailing address

10051 PINES BLVD STE C
PEMBROKE PINES FL
33024-6172
US

V. Phone/Fax

Practice location:
  • Phone: 954-317-0236
  • Fax: 954-543-1600
Mailing address:
  • Phone: 954-317-0236
  • Fax: 954-543-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN182052
License Number StateFL

VIII. Authorized Official

Name: MARITZA T LAZCANO
Title or Position: DENTIST
Credential: D.D.S
Phone: 954-317-0236