Provider Demographics
NPI:1235248170
Name:LAZERSON, ROBERT M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:LAZERSON
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:3020 ROSWELL RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4996
Mailing Address - Country:US
Mailing Address - Phone:770-565-8730
Mailing Address - Fax:770-509-2323
Practice Address - Street 1:3020 ROSWELL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4996
Practice Address - Country:US
Practice Address - Phone:770-565-8730
Practice Address - Fax:770-509-2323
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0081321223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology