NPIMap

Organization Active NPI

Jack R. Lazer, D.M.D., P.C.

  • General Practice Dentistry
  • Johnstown, PA
National Provider Identifier
1194890418
Registry record updated Mar 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS021727L Issued in PA
Legal business name
JACK R. LAZER, D.M.D., P.C.
Practice address
105 McCort Place
Johnstown, PA 15904
Phone
(814) 269-4404
Fax
(814) 266-8668
NPI assigned
Nov 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tracy L. Croyle
Title
Secretary/Ins. Billing
Phone
(814) 269-4404

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DS021727L PA
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X DS021727L PA Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X DS023637L PA

Addresses

Primary practice location

105 McCort Place
Johnstown, PA 15904

Mailing address

105 McCort Place
Johnstown, PA 15904
Phone (814) 269-4404

National Provider Directory

National Provider Directory

Locations

105 McCort Pl
Johnstown, PA 15904
Phone (814) 269-4404

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332979200000",
    "number": "1194890418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 MCCORT PLACE",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "15904",
            "telephone_number": "814-269-4404",
            "fax_number": "814-266-8668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MCCORT PLACE",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "15904",
            "telephone_number": "814-269-4404",
            "fax_number": "814-266-8668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK R. LAZER, D.M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2012-03-29",
        "status": "A",
        "authorized_official_last_name": "CROYLE",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "SECRETARY/INS. BILLING",
        "authorized_official_telephone_number": "814-269-4404"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS021727L",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS021727L",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS023637L",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnstown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.