Provider Demographics
NPI:1801909429
Name:LAZOR, RICHARD HARVEY (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HARVEY
Last Name:LAZOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11719 WHISPER VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3739
Mailing Address - Country:US
Mailing Address - Phone:210-492-2192
Mailing Address - Fax:210-493-6042
Practice Address - Street 1:11719 WHISPER VALLEY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3739
Practice Address - Country:US
Practice Address - Phone:210-492-2192
Practice Address - Fax:210-493-6042
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD11754OtherBC/BS
TX667994OtherUNITED CONCORDIA