Provider Demographics
NPI:1851572911
Name:LAZARE, MARC EVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:EVAN
Last Name:LAZARE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:115 E 61ST ST
Mailing Address - Street 2:SUITE 14A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8183
Mailing Address - Country:US
Mailing Address - Phone:212-861-2599
Mailing Address - Fax:212-861-2540
Practice Address - Street 1:115 E 61ST ST
Practice Address - Street 2:SUITE 14A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8183
Practice Address - Country:US
Practice Address - Phone:212-861-2599
Practice Address - Fax:212-861-2540
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0468401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice