Healthcare Provider Details

I. General information

NPI: 1851539456
Provider Name (Legal Business Name): ANTHONY J. LAZZARO DMD,MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MCKEAN AVE
CHARLEROI PA
15022-1413
US

IV. Provider business mailing address

226 MCKEAN AVE
CHARLEROI PA
15022-1413
US

V. Phone/Fax

Practice location:
  • Phone: 724-489-4867
  • Fax:
Mailing address:
  • Phone: 724-489-4867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS022332-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: