Provider Demographics
NPI:1992908313
Name:LAZEAR, MICHAEL RANDOLPH (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RANDOLPH
Last Name:LAZEAR
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 1:6209 THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1221
Mailing Address - Country:US
Mailing Address - Phone:703-282-4642
Mailing Address - Fax:
Practice Address - Street 1:8134 OLD KEENE MILL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1800
Practice Address - Country:US
Practice Address - Phone:703-569-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-4118261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice