Provider Demographics
NPI:1124195607
Name:HAZIM, PETER F (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:F
Last Name:HAZIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:FIRAS
Other - Middle Name:
Other - Last Name:ALHAZIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 N ALMA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3360
Mailing Address - Country:US
Mailing Address - Phone:972-978-2616
Mailing Address - Fax:972-727-5592
Practice Address - Street 1:105 N ALMA DR STE 100
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3360
Practice Address - Country:US
Practice Address - Phone:972-978-2616
Practice Address - Fax:972-727-5592
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX184051223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics