Provider Demographics
NPI:1154394146
Name:LAZO, ALVARO R (DMD)
Entity type:Individual
Prefix:
First Name:ALVARO
Middle Name:R
Last Name:LAZO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 FIRWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1862
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1325 FIRWOOD DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1862
Practice Address - Country:US
Practice Address - Phone:412-276-3037
Practice Address - Fax:412-564-4661
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030094L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2203172Medicaid
PA0017686540004Medicaid
WV4005100-000Medicaid