Provider Demographics
NPI:1699874750
Name:HAZEN, JOHN C II (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:HAZEN
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:C
Other - Last Name:HAZEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:413 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2703
Mailing Address - Country:US
Mailing Address - Phone:608-251-8790
Mailing Address - Fax:608-251-0242
Practice Address - Street 1:413 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2703
Practice Address - Country:US
Practice Address - Phone:608-251-8790
Practice Address - Fax:608-251-0242
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice