Provider Demographics
NPI:1376089904
Name:MCCAUGHAN, HAZEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:HAZEL
Middle Name:
Last Name:MCCAUGHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 OAKMONT TRL
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-8718
Mailing Address - Country:US
Mailing Address - Phone:601-605-9552
Mailing Address - Fax:
Practice Address - Street 1:1149 OLD FANNIN RD
Practice Address - Street 2:#26
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-9244
Practice Address - Country:US
Practice Address - Phone:601-992-7972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3063-98122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist