Provider Demographics
NPI:1295466928
Name:BACHOUR, LARA (DMD, MDS)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:
Last Name:BACHOUR
Suffix:
Gender:F
Credentials:DMD, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 ADAMS TER
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-4046
Mailing Address - Country:US
Mailing Address - Phone:614-440-7317
Mailing Address - Fax:
Practice Address - Street 1:1950 LAUREL MANOR DR STE 184
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5608
Practice Address - Country:US
Practice Address - Phone:352-753-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING1223E0200X
FLDA272801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics