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General NPI Number Information
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NPI Number | 1942470422
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Entity Type | Individual
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Provider Name | MARITZA T LAZCANO DDS
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Gender | Female
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 12/03/2019
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Provider Practice Location Address
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Address Line | 2708 E ATLANTIC BLVD
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City | POMPANO BEACH
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State | FL
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Zip | 33062-4942
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Country | US
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Telephone | 954-941-6882
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Fax | 954-941-7112
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Provider Business Mailing Address
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Address Line | 15355 SHERMAN WAY STE P
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City | VAN NUYS
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State | CA
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Zip | 91406-4200
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Country | US
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Telephone | 818-571-0782
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Fax |
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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 | DDS101016
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN18205
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License Number State | FL
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