Healthcare Provider Details

I. General information

NPI: 1326891102
Provider Name (Legal Business Name): JULIA LAZZARA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5189
US

IV. Provider business mailing address

2301 E ALLEGHENY AVE
PHILADELPHIA PA
19134-4427
US

V. Phone/Fax

Practice location:
  • Phone: 800-836-7536
  • Fax:
Mailing address:
  • Phone: 215-282-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS044729
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: