Provider Demographics
NPI:1932310844
Name:LAZARCHUK, PETER WALTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:WALTER
Last Name:LAZARCHUK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1900
Mailing Address - Country:US
Mailing Address - Phone:224-820-3228
Mailing Address - Fax:
Practice Address - Street 1:42450 W 12 MILE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3013
Practice Address - Country:US
Practice Address - Phone:248-348-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013169122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist