Provider Demographics
NPI:1174679914
Name:ROBERT HAZANY DDS A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:ROBERT HAZANY DDS A PROFESSIONAL CORP
Other - Org Name:WESTSIDE DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZANY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-998-7645
Mailing Address - Street 1:20832 ROSCOE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91306
Mailing Address - Country:US
Mailing Address - Phone:818-998-7645
Mailing Address - Fax:818-998-8457
Practice Address - Street 1:20832 ROSCOE BLVD
Practice Address - Street 2:SUITE #101
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91306
Practice Address - Country:US
Practice Address - Phone:818-998-7645
Practice Address - Fax:818-998-8457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39963122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty