Organization
JACK R. LAZER, D.M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY L. CROYLE (SECRETARY/INS. BILLING)
(814) 269-4404
Entity
Organization
Contact information
Practice address
105 MCCORT PLACE, JOHNSTOWN, PA 15904
(814) 269-4404
(814) 266-8668
Mailing address
105 MCCORT PLACE, JOHNSTOWN, PA 15904
(814) 269-4404
(814) 266-8668
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS021727L
PA
1223G0001X
General Practice Dentistry
Primary
DS021727L
PA
1223G0001X
General Practice Dentistry
DS023637L
PA
Other
Enumeration date
11/21/2006
Last updated
03/29/2012
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