Provider Demographics
NPI:1083068928
Name:LAZARI, PAUL (DDS,MS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LAZARI
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 W CHESTNUT ST
Mailing Address - Street 2:APT 26D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3338
Mailing Address - Country:US
Mailing Address - Phone:408-781-2933
Mailing Address - Fax:
Practice Address - Street 1:8 W CHESTNUT ST
Practice Address - Street 2:APT 26D
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3338
Practice Address - Country:US
Practice Address - Phone:408-781-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210027451223X0400X
IL019030331122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist