Provider Demographics
NPI:1841462801
Name:LAZZARA, GASPER (DDS)
Entity type:Individual
Prefix:DR
First Name:GASPER
Middle Name:
Last Name:LAZZARA
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 1:5000 SAWGRASS VILLAGE CIR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-5045
Mailing Address - Country:US
Mailing Address - Phone:904-567-1400
Mailing Address - Fax:904-273-6068
Practice Address - Street 1:5000 SAWGRASS VILLAGE CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-5045
Practice Address - Country:US
Practice Address - Phone:904-567-1400
Practice Address - Fax:904-273-6068
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN43531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics