Provider Demographics
NPI:1508903758
Name:J. TAYLOR HAZARD, DMD & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:J. TAYLOR HAZARD, DMD & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:HAZARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-366-4121
Mailing Address - Street 1:4701 SOUTHERN PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-1424
Mailing Address - Country:US
Mailing Address - Phone:502-366-4121
Mailing Address - Fax:
Practice Address - Street 1:4701 SOUTHERN PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-1424
Practice Address - Country:US
Practice Address - Phone:502-366-4121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY57811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60057817Medicaid