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Provider Information for 1104075944



DR. DAVID HAZAN DMD, B.ENG

Gender: MALE

Individual NPI: 1104075944

Calendar Last Updated: 2008-09-17

Details

Name Value
NPI 1104075944
Enumeration Date 2008-09-17
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 385 DOUGLAS AVE SUITE 2450
ALTAMONTE SPRINGS, FL 32714-3325
United States

Phone: 407-677-5400 | Fax: 407-677-5402
View Map External Link
Primary Practice Address 385 DOUGLAS AVE SUITE 2450
ALTAMONTE SPRINGS, FL 32714-3325
United States

Phone: 407-677-5400 | Fax: 407-677-5402
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist FL DN14745
Other Identifiers
Issuer State Number
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location