Healthcare Provider Details

I. General information

NPI: 1992635304
Provider Name (Legal Business Name): LANE H BAZAR DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 MOOSA BLVD
EUNICE LA
70535-3627
US

IV. Provider business mailing address

481 MOOSA BLVD
EUNICE LA
70535-3627
US

V. Phone/Fax

Practice location:
  • Phone: 337-308-1853
  • Fax:
Mailing address:
  • Phone: 337-308-1853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LANE BAZAR
Title or Position: MEMBER
Credential: DDS
Phone: 337-308-1853