Healthcare Provider Details

I. General information

NPI: 1528210747
Provider Name (Legal Business Name): EDWARD S LAZER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PARK CENTER CT SUITE 302
OWINGS MILLS MD
21117-4201
US

IV. Provider business mailing address

5 PARK CENTER CT SUITE 302
OWINGS MILLS MD
21117-4201
US

V. Phone/Fax

Practice location:
  • Phone: 410-356-7799
  • Fax: 410-356-4445
Mailing address:
  • Phone: 410-356-7799
  • Fax: 410-356-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11199
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: