Provider Demographics
NPI:1184017212
Name:LZ MANOV D.D.S. P.C.
Entity Type:Organization
Organization Name:LZ MANOV D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUBOMIR
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MANOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-788-0730
Mailing Address - Street 1:15255 N 40TH ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4624
Mailing Address - Country:US
Mailing Address - Phone:602-788-0730
Mailing Address - Fax:602-635-7438
Practice Address - Street 1:15255 N 40TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4624
Practice Address - Country:US
Practice Address - Phone:602-788-0730
Practice Address - Fax:602-635-7438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4450122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty