Provider Demographics
NPI:1386716231
Name:LAZARCHUK, IRENE S (DDS)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:S
Last Name:LAZARCHUK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43928 MOUND RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314
Mailing Address - Country:US
Mailing Address - Phone:586-803-1901
Mailing Address - Fax:586-803-1907
Practice Address - Street 1:43928 MOUND RD
Practice Address - Street 2:SUITE 150
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314
Practice Address - Country:US
Practice Address - Phone:586-803-1901
Practice Address - Fax:586-803-1907
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11832122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist