Healthcare Provider Details

I. General information

NPI: 1083068928
Provider Name (Legal Business Name): PAUL LAZARI DDS,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 W CHESTNUT ST APT 26D
CHICAGO IL
60610-3338
US

IV. Provider business mailing address

8 W CHESTNUT ST APT 26D
CHICAGO IL
60610-3338
US

V. Phone/Fax

Practice location:
  • Phone: 408-781-2933
  • Fax:
Mailing address:
  • Phone: 408-781-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021002745
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019030331
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: