Provider Demographics
NPI:1447307608
Name:LAZAROFF, STUART A (DMD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:A
Last Name:LAZAROFF
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 1:17 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2302
Mailing Address - Country:US
Mailing Address - Phone:203-239-7645
Mailing Address - Fax:203-239-2923
Practice Address - Street 1:17 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2302
Practice Address - Country:US
Practice Address - Phone:203-239-7645
Practice Address - Fax:203-239-2923
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0076161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice