Provider Demographics
NPI:1083969323
Name:ACOSTA, LAZARO (DDS)
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:
Last Name:ACOSTA
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 1:7032 AMBROSIA LN APT 707
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-9652
Mailing Address - Country:US
Mailing Address - Phone:813-598-4301
Mailing Address - Fax:
Practice Address - Street 1:15215 COLLIER BLVD
Practice Address - Street 2:SUITE 314
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-6834
Practice Address - Country:US
Practice Address - Phone:239-793-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19886122300000X
FLDN 19886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist