Provider Demographics
NPI:1588787683
Name:HAZELRIGG, DAVID ERIC (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC
Last Name:HAZELRIGG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-2636
Mailing Address - Country:US
Mailing Address - Phone:812-476-2414
Mailing Address - Fax:812-476-2414
Practice Address - Street 1:3001 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-2636
Practice Address - Country:US
Practice Address - Phone:812-476-2414
Practice Address - Fax:812-476-2414
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009764A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice