Individual
DR. JAMIE LAZIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS, MSD
Contact information
Practice address
11 E 58TH ST, INDIANAPOLIS, IN 46220-2519
(404) 931-1576
Mailing address
11 E 58TH ST, INDIANAPOLIS, IN 46220-2519
(404) 931-1576
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12012549A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1201549A
DENTAL LICENSE
IN
Enumeration date
06/30/2016
Last updated
06/30/2016
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