Provider Demographics
NPI:1972715712
Name:FERNANDEZ, LAZARO C (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAZARO
Middle Name:C
Last Name:FERNANDEZ
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 1:8180 N.W. 155 STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-512-9250
Mailing Address - Fax:305-512-9257
Practice Address - Street 1:8180 N.W. 155 STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-512-9250
Practice Address - Fax:305-512-9257
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-0014160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist