Healthcare Provider Details

I. General information

NPI: 1912540162
Provider Name (Legal Business Name): ELENA LAZARI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELENA CUCEROV

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MAIN ST
NASHUA NH
03060-2725
US

IV. Provider business mailing address

38 MAIN ST APT 17
NORTH READING MA
01864-2221
US

V. Phone/Fax

Practice location:
  • Phone: 603-556-7043
  • Fax:
Mailing address:
  • Phone: 857-234-2743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number04526
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: