Provider Demographics
NPI:1669604245
Name:DR. EDWARD S. LAZER, D.D.S., P.C.
Entity type:Organization
Organization Name:DR. EDWARD S. LAZER, D.D.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAZER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-356-7799
Mailing Address - Street 1:5 PARK CENTER CT
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4201
Mailing Address - Country:US
Mailing Address - Phone:410-356-7799
Mailing Address - Fax:410-356-4445
Practice Address - Street 1:5 PARK CENTER CT
Practice Address - Street 2:SUITE 302
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4201
Practice Address - Country:US
Practice Address - Phone:410-356-7799
Practice Address - Fax:410-356-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8210122300000X
MD137321223E0200X
MD11199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty