Provider Demographics
NPI:1982270708
Name:LAZENBY, CRAIG A (DMD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:LAZENBY
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 1:985 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2835
Mailing Address - Country:US
Mailing Address - Phone:850-988-1777
Mailing Address - Fax:918-310-1056
Practice Address - Street 1:985 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2835
Practice Address - Country:US
Practice Address - Phone:850-988-1777
Practice Address - Fax:850-889-7999
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL281351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice