Provider Demographics
NPI:1992133318
Name:ROBERT HAZE DDS, INC.
Entity type:Organization
Organization Name:ROBERT HAZE DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-267-4000
Mailing Address - Street 1:1021 W AVENUE M14
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1440
Mailing Address - Country:US
Mailing Address - Phone:661-267-4000
Mailing Address - Fax:661-267-4018
Practice Address - Street 1:1021 W AVENUE M14
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1440
Practice Address - Country:US
Practice Address - Phone:661-267-4000
Practice Address - Fax:661-267-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA358831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1972629640OtherDENTI-CAL
CA1992133318OtherDENTI-CAL