Individual
DR. AMANDA BRANNAN LAZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
895 RIO EAST CT, CHARLOTTESVILLE, VA 22901-8004
(434) 817-5437
Mailing address
2536 W SIMMS BLVD, TAMPA, FL 33609-5313
(813) 546-9810
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401415059
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
NE
Other
Enumeration date
05/22/2012
Last updated
06/09/2016
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