Healthcare Provider Details

I. General information

NPI: 1942470422
Provider Name (Legal Business Name): MARITZA T LAZCANO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 E ATLANTIC BLVD
POMPANO BEACH FL
33062-4942
US

IV. Provider business mailing address

15355 SHERMAN WAY STE P
VAN NUYS CA
91406-4200
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-6882
  • Fax: 954-941-7112
Mailing address:
  • Phone: 818-571-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS101016
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN18205
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: