Provider Demographics
NPI:1063589737
Name:HAZEY, CARRIE ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:HAZEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 BRIARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9449
Mailing Address - Country:US
Mailing Address - Phone:304-842-2465
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV35721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice