Provider Demographics
NPI:1427115922
Name:CHANZA, LAZARUS (DDS)
Entity type:Individual
Prefix:DR
First Name:LAZARUS
Middle Name:
Last Name:CHANZA
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:PO BOX 3136
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-3136
Mailing Address - Country:US
Mailing Address - Phone:909-581-0244
Mailing Address - Fax:
Practice Address - Street 1:8977 FOOTHILL BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3498
Practice Address - Country:US
Practice Address - Phone:909-581-0244
Practice Address - Fax:909-518-0344
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice