Provider Demographics
NPI:1649234691
Name:LIZZACK, LAWRENCE STEVEN
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:STEVEN
Last Name:LIZZACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17-10 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1252
Mailing Address - Country:US
Mailing Address - Phone:201-797-7774
Mailing Address - Fax:
Practice Address - Street 1:17-10 RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1252
Practice Address - Country:US
Practice Address - Phone:201-797-7774
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009443001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice