Provider Demographics
NPI:1821294158
Name:LAZAR, CHAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:LAZAR
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 1:14 LANTERN LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1622
Mailing Address - Country:US
Mailing Address - Phone:856-482-0308
Mailing Address - Fax:856-667-5773
Practice Address - Street 1:321 CAMPBELL DR
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1032
Practice Address - Country:US
Practice Address - Phone:609-877-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053385122300000X
PADS037112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist