Provider Demographics
NPI:1639100316
Name:LAZARCHIK, DAVID A (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:LAZARCHIK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 E SECOND ST SUITE 8
Mailing Address - Street 2:WESTERN UNIVERSITY DENTAL CARE CENTER
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2020
Mailing Address - Country:US
Mailing Address - Phone:909-706-3910
Mailing Address - Fax:909-706-3878
Practice Address - Street 1:795 E SECOND ST SUITE 8
Practice Address - Street 2:WESTERN UNIVERSITY DENTAL CARE CENTER
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2020
Practice Address - Country:US
Practice Address - Phone:909-706-3910
Practice Address - Fax:909-706-3878
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA567571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZG3325Medicaid
GA438842543AMedicaid