Provider Demographics
NPI:1104075944
Name:HAZAN, DAVID (DMD, BENG)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:HAZAN
Suffix:
Gender:M
Credentials:DMD, BENG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 DOUGLAS AVE
Mailing Address - Street 2:SUITE 2450
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3325
Mailing Address - Country:US
Mailing Address - Phone:407-677-5400
Mailing Address - Fax:407-677-5402
Practice Address - Street 1:385 DOUGLAS AVE
Practice Address - Street 2:SUITE 2450
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3325
Practice Address - Country:US
Practice Address - Phone:407-677-5400
Practice Address - Fax:407-677-5402
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14745122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist