MEDICARE: DR. ROBERT DAVID LAZAROFF DDS

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	1223P0700X	Prosthodontics	3712	SC

General Provider Information

NPI Number	:	1942360482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DAVID LAZAROFF DDS

Provider Business Mailing Address
First Line	:	3017 NEW CASTLE LOOP
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588
Country	:	US
Telephone Number	:	843-215-4343
Fax Number	:	843-215-4344

Provider Business Practice Location Address
First Line	:	3017 NEW CASTLE LOOP
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588
Country	:	US
Telephone Number	:	843-215-4343
Fax Number	:	843-215-4344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	01/10/2012

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