Provider Demographics
NPI:1164753240
Name:LAZARUS, JOHN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:LAZARUS
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 1:4250 PONTIAC LAKE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1281
Mailing Address - Country:US
Mailing Address - Phone:248-674-3136
Mailing Address - Fax:248-674-3138
Practice Address - Street 1:4250 PONTIAC LAKE RD
Practice Address - Street 2:SUITE A
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1281
Practice Address - Country:US
Practice Address - Phone:248-674-3136
Practice Address - Fax:248-674-3138
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI9548122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist