Provider Demographics
NPI:1700149192
Name:BENJAMIN LAZAROFF, CHRISTY MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:MARIE
Last Name:BENJAMIN LAZAROFF
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19076-1414
Mailing Address - Country:US
Mailing Address - Phone:610-583-5052
Mailing Address - Fax:
Practice Address - Street 1:907 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:PA
Practice Address - Zip Code:19076-1414
Practice Address - Country:US
Practice Address - Phone:610-583-5052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist