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General NPI Number Information
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NPI Number | 1295340990
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Entity Type | Organization
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Legal Business Name | PAUL LAZARI LLC
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 161 N MARION ST
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City | OAK PARK
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State | IL
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Zip | 60301-1032
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Country | US
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Telephone | 708-613-5023
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Fax |
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Provider Business Mailing Address
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Address Line | 161 N MARION ST
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City | OAK PARK
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State | IL
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Zip | 60301-1032
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Country | US
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Telephone | 708-613-5023
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL LAZARI
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Credential | DDS
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Telephone | 408-781-2933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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