Provider Demographics
NPI:1497002075
Name:LAZORE, DARIENE V (DMD)
Entity Type:Individual
Prefix:DR
First Name:DARIENE
Middle Name:V
Last Name:LAZORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 W HAPPY VALLEY RD STE B103-104
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-2608
Mailing Address - Country:US
Mailing Address - Phone:232-678-0886
Mailing Address - Fax:
Practice Address - Street 1:6615 W HAPPY VALLEY RD STE B103-104
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-2608
Practice Address - Country:US
Practice Address - Phone:623-267-9367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008523122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist