Provider Demographics
NPI:1326279498
Name:AMANDA EWING HASZINGER, DDS
Entity Type:Organization
Organization Name:AMANDA EWING HASZINGER, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:EWING
Authorized Official - Last Name:HASZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-443-5882
Mailing Address - Street 1:3645 WILLIAMS BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3464
Mailing Address - Country:US
Mailing Address - Phone:504-443-5882
Mailing Address - Fax:504-324-0952
Practice Address - Street 1:3645 WILLIAMS BLVD
Practice Address - Street 2:STE 103
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3464
Practice Address - Country:US
Practice Address - Phone:504-443-5882
Practice Address - Fax:504-324-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5802122300000X
LA57991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty