Provider Demographics
NPI:1174826275
Name:MICHAEL A. HAZEY II, D.D.S., INC.
Entity type:Organization
Organization Name:MICHAEL A. HAZEY II, D.D.S., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAZEY
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-622-0595
Mailing Address - Street 1:720 E PIKE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2240
Mailing Address - Country:US
Mailing Address - Phone:304-622-0595
Mailing Address - Fax:304-622-6290
Practice Address - Street 1:720 E PIKE ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2240
Practice Address - Country:US
Practice Address - Phone:304-622-0595
Practice Address - Fax:304-622-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2255261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCKWV1Medicaid