Provider Demographics
NPI:1467463935
Name:HAZEN, RYANNE (DDS)
Entity Type:Individual
Prefix:
First Name:RYANNE
Middle Name:
Last Name:HAZEN
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 1:3027 ROLLING HILLS LN
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-6451
Mailing Address - Country:US
Mailing Address - Phone:407-889-8418
Mailing Address - Fax:
Practice Address - Street 1:19001 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6708
Practice Address - Country:US
Practice Address - Phone:352-383-9406
Practice Address - Fax:352-383-9539
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN176741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice