Provider Demographics
NPI:1861556441
Name:KAVOUKLIS, LAZARUS NICK (DMD)
Entity type:Individual
Prefix:DR
First Name:LAZARUS
Middle Name:NICK
Last Name:KAVOUKLIS
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 1:6421 SHELDON ROAD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3102
Mailing Address - Country:US
Mailing Address - Phone:813-888-9004
Mailing Address - Fax:813-888-9517
Practice Address - Street 1:6421 SHELDON ROAD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3102
Practice Address - Country:US
Practice Address - Phone:813-888-9004
Practice Address - Fax:813-888-9517
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN59331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice