Provider Demographics
NPI:1225351729
Name:LAZAROF, SARGON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARGON
Middle Name:
Last Name:LAZAROF
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 1:16101 VENTURA BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2500
Mailing Address - Country:US
Mailing Address - Phone:818-380-9057
Mailing Address - Fax:818-380-9059
Practice Address - Street 1:16101 VENTURA BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2500
Practice Address - Country:US
Practice Address - Phone:818-380-9057
Practice Address - Fax:818-380-9059
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA353681223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice