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General NPI Number Information
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NPI Number | 1568685147
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Entity Type | Individual
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Provider Name | RALPH LAZARO DDS
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Gender | Male
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 737 WALKER RD SUITE 6
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City | GREAT FALLS
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State | VA
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Zip | 22066-2833
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Country | US
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Telephone | 703-759-3011
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Fax | 703-759-6030
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Provider Business Mailing Address
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Address Line | 737 WALKER RD SUITE 6
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City | GREAT FALLS
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State | VA
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Zip | 22066-2833
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Country | US
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Telephone | 703-759-3011
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Fax | 703-759-6030
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401004449
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License Number State | VA
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