Provider Demographics
NPI:1578671079
Name:LAZUR, JOHN G JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:LAZUR
Suffix:JR
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:P.O. BOX 280
Mailing Address - Street 2:2 BALDWIN BLVD
Mailing Address - City:SHAMOKIN DAM
Mailing Address - State:PA
Mailing Address - Zip Code:17876
Mailing Address - Country:US
Mailing Address - Phone:570-743-3300
Mailing Address - Fax:570-743-7555
Practice Address - Street 1:2 BALDWIN BLVD.
Practice Address - Street 2:
Practice Address - City:SHAMOKIN DAM
Practice Address - State:PA
Practice Address - Zip Code:17876
Practice Address - Country:US
Practice Address - Phone:570-743-3300
Practice Address - Fax:570-743-7555
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS18163L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice