Provider Demographics
NPI:1992877385
Name:HAZEN, CHARLES RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:HAZEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1529
Mailing Address - Street 2:131 1ST AVE. SOUTH
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-1529
Mailing Address - Country:US
Mailing Address - Phone:907-766-6372
Mailing Address - Fax:907-766-2581
Practice Address - Street 1:131 1ST AVE. SOUTH
Practice Address - Street 2:
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827-1529
Practice Address - Country:US
Practice Address - Phone:907-766-6372
Practice Address - Fax:907-766-2581
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKDEN D 5411223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health