Provider Demographics
NPI:1740576552
Name:ED LAZER DDS PC
Entity Type:Organization
Organization Name:ED LAZER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-356-7799
Mailing Address - Street 1:1810 BEL AIR RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2729
Mailing Address - Country:US
Mailing Address - Phone:410-877-7900
Mailing Address - Fax:410-877-8455
Practice Address - Street 1:1810 BEL AIR RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2729
Practice Address - Country:US
Practice Address - Phone:410-877-7900
Practice Address - Fax:410-877-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty