Provider Demographics
NPI:1154438125
Name:LAZAR, BENVA (DMD)
Entity type:Individual
Prefix:DR
First Name:BENVA
Middle Name:
Last Name:LAZAR
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 1:5710 CAHALAN AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123
Mailing Address - Country:US
Mailing Address - Phone:408-224-4155
Mailing Address - Fax:408-578-5518
Practice Address - Street 1:5710 CAHALAN AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123
Practice Address - Country:US
Practice Address - Phone:408-224-4155
Practice Address - Fax:408-578-5518
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice