Provider Demographics
NPI:1003036211
Name:LAZAR, DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:
Last Name:LAZAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-0730
Mailing Address - Country:US
Mailing Address - Phone:804-435-3008
Mailing Address - Fax:804-435-9239
Practice Address - Street 1:283 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-435-3008
Practice Address - Fax:804-435-9239
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010057341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice