Provider Demographics
NPI:1437040839
Name:LAZZARA, ALEXANDER JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JOHN
Last Name:LAZZARA
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 1:1655 MURDOCK RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4828
Mailing Address - Country:US
Mailing Address - Phone:904-945-0526
Mailing Address - Fax:
Practice Address - Street 1:8200 ROBERTS DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-4147
Practice Address - Country:US
Practice Address - Phone:770-504-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123856122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist