Provider Demographics
NPI:1639154719
Name:LAZO, TADEO SINGSON (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:TADEO
Middle Name:SINGSON
Last Name:LAZO
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-4914
Mailing Address - Country:US
Mailing Address - Phone:845-356-0788
Mailing Address - Fax:
Practice Address - Street 1:33 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-4914
Practice Address - Country:US
Practice Address - Phone:845-356-0788
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice