# JACK R. LAZER, D.M.D., P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194890418
- **Authorized official:** TRACY L. CROYLE (SECRETARY/INS. BILLING)
- **Authorized official phone:** (814) 269-4404

## Contact information

- **Practice address:** 105 MCCORT PLACE, JOHNSTOWN, PA 15904
- **Practice address phone:** (814) 269-4404
- **Practice address fax:** (814) 266-8668
- **Mailing address:** 105 MCCORT PLACE, JOHNSTOWN, PA 15904
- **Mailing address phone:** (814) 269-4404
- **Mailing address fax:** (814) 266-8668

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DS021727L | PA | — |
| 1223G0001X | General Practice Dentistry | DS021727L | PA | Yes |
| 1223G0001X | General Practice Dentistry | DS023637L | PA | — |

## Other

- **Enumeration date:** 11/21/2006
- **Last updated:** 03/29/2012