Provider Demographics
NPI:1700070372
Name:LAZAR, KEYVAN KEVIN (DDS)
Entity Type:Individual
Prefix:
First Name:KEYVAN
Middle Name:KEVIN
Last Name:LAZAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:LAZAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:247 EAST PALMDALE BLVD
Mailing Address - Street 2:SUITE # E
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550
Mailing Address - Country:US
Mailing Address - Phone:661-265-9400
Mailing Address - Fax:
Practice Address - Street 1:247 E PALMDALE BLVD
Practice Address - Street 2:SUITE # E
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4557
Practice Address - Country:US
Practice Address - Phone:661-265-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473821223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics