Provider Demographics
NPI:1417737859
Name:MCCOY Y LAZO, CAROLINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:
Last Name:MCCOY Y LAZO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 E. THOMPSON BLVD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-5935
Mailing Address - Country:US
Mailing Address - Phone:805-648-5351
Mailing Address - Fax:805-643-0310
Practice Address - Street 1:798 E. THOMPSON BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-5935
Practice Address - Country:US
Practice Address - Phone:805-648-5351
Practice Address - Fax:805-643-0310
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist