Provider Demographics
NPI:1861757460
Name:LAZAR, ADAM MINEAR (DMD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MINEAR
Last Name:LAZAR
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 1:304 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1206
Mailing Address - Country:US
Mailing Address - Phone:407-921-8662
Mailing Address - Fax:
Practice Address - Street 1:304 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1206
Practice Address - Country:US
Practice Address - Phone:407-841-7321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2018-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL198311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice