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General NPI Number Information
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NPI Number | 1447694799
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Entity Type | Organization
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Legal Business Name | LAZCANO FAMILY DENTAL P.A
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Dates
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Enumeration Date | 04/17/2013
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 10051 PINES BLVD STE C
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6172
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Country | US
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Telephone | 954-317-0236
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Fax | 954-543-1600
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Provider Business Mailing Address
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Address Line | 10051 PINES BLVD STE C
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6172
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Country | US
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Telephone | 954-317-0236
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Fax | 954-543-1600
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Authorized Official
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Title or Position | DENTIST
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Name | MARITZA T LAZCANO
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Credential | D.D.S
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Telephone | 954-317-0236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN182052
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License Number State | FL
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