Provider Demographics
NPI:1992937429
Name:HAZAN, ANN MIRIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:MIRIAM
Last Name:HAZAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PARK ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1365
Mailing Address - Country:US
Mailing Address - Phone:315-386-3886
Mailing Address - Fax:315-386-1844
Practice Address - Street 1:22 PARK ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1365
Practice Address - Country:US
Practice Address - Phone:315-386-3886
Practice Address - Fax:315-386-1844
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50-054558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist