Provider Demographics
NPI:1568685147
Name:LAZARO, RALPH (DDS)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:LAZARO
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 1:737 WALKER RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2833
Mailing Address - Country:US
Mailing Address - Phone:703-759-3011
Mailing Address - Fax:703-759-6030
Practice Address - Street 1:737 WALKER RD
Practice Address - Street 2:SUITE 6
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-2833
Practice Address - Country:US
Practice Address - Phone:703-759-3011
Practice Address - Fax:703-759-6030
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401004449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist