Provider Demographics
NPI:1942470422
Name:LAZCANO, MARITZA T (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:T
Last Name:LAZCANO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15355 SHERMAN WAY STE P
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4200
Mailing Address - Country:US
Mailing Address - Phone:818-571-0782
Mailing Address - Fax:
Practice Address - Street 1:2708 E ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-4942
Practice Address - Country:US
Practice Address - Phone:954-941-6882
Practice Address - Fax:954-941-7112
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS101016122300000X
FLDN182051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist