Healthcare Provider Details

I. General information

NPI: 1649268582
Provider Name (Legal Business Name): JOHN M LAZOR JR. D.D.S.,FADSA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 SCHNEIDER ST SE
NORTH CANTON OH
44720-3745
US

IV. Provider business mailing address

815 SCHNEIDER ST SE
NORTH CANTON OH
44720-3745
US

V. Phone/Fax

Practice location:
  • Phone: 330-499-2367
  • Fax: 330-497-4987
Mailing address:
  • Phone: 330-499-2367
  • Fax: 330-497-4987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-01-3915
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number231
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: