MEDICARE: BENVA O. LAZAR DMD & BERNA SANAYEI DDS INCORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1649303264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENVA O. LAZAR DMD & BERNA SANAYEI DDS INCORPORATION

Provider Business Mailing Address
First Line	:	2929 THE VILLAGES PKWY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95135-1442
Country	:	US
Telephone Number	:	408-274-9554
Fax Number	:	408-274-4320

Provider Business Practice Location Address
First Line	:	2929 THE VILLAGES PKWY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95135-1442
Country	:	US
Telephone Number	:	408-274-9554
Fax Number	:	408-274-4320

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. RAJI JOHL
Credential	:
Telephone Number	:	408-274-9554

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/22/2020

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