Provider Demographics
NPI:1508900051
Name:CLAYTON G. HAZELTON DMD PC
Entity Type:Organization
Organization Name:CLAYTON G. HAZELTON DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAZELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-943-1234
Mailing Address - Street 1:1029 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-5134
Mailing Address - Country:US
Mailing Address - Phone:401-943-1234
Mailing Address - Fax:401-943-1297
Practice Address - Street 1:1029 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-5134
Practice Address - Country:US
Practice Address - Phone:401-943-1234
Practice Address - Fax:401-943-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN23731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty