Provider Demographics
NPI:1568682870
Name:DRS. WEIDMAN AND HAZEY III, PLLC
Entity type:Organization
Organization Name:DRS. WEIDMAN AND HAZEY III, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAZEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:304-598-2500
Mailing Address - Street 1:918 CHESTNUT RIDGE PROF. BLDG.
Mailing Address - Street 2:SUITE #5
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2822
Mailing Address - Country:US
Mailing Address - Phone:304-598-2500
Mailing Address - Fax:304-598-2517
Practice Address - Street 1:918 CHESTNUT RIDGE PROF. BLDG.
Practice Address - Street 2:SUITE #5
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2822
Practice Address - Country:US
Practice Address - Phone:304-598-2500
Practice Address - Fax:304-598-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV165-944-8991OtherNPI NUMBER
WV177-065-0012OtherNPI NUMBER
WV163-924-6887OtherNPI NUMBER