Provider Demographics
NPI:1225196165
Name:LAZO, ANTONIO MABURTAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:MABURTAS
Last Name:LAZO
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 1:9928 KESWICK ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-1022
Mailing Address - Country:US
Mailing Address - Phone:818-768-2246
Mailing Address - Fax:
Practice Address - Street 1:9755 ALONDRA BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-3677
Practice Address - Country:US
Practice Address - Phone:562-925-3842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519551223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health