Provider Demographics
NPI:1740379064
Name:LAZARUS, HENRY LEON (DM D)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:LEON
Last Name:LAZARUS
Suffix:
Gender:M
Credentials:DM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3610
Mailing Address - Country:US
Mailing Address - Phone:215-382-5126
Mailing Address - Fax:
Practice Address - Street 1:4603 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3610
Practice Address - Country:US
Practice Address - Phone:215-382-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020800L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice