Provider Demographics
NPI:1770212318
Name:HAZIMAH, DANIEL YOUSSEF
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:YOUSSEF
Last Name:HAZIMAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5243 EAGLE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1302
Mailing Address - Country:US
Mailing Address - Phone:419-389-3890
Mailing Address - Fax:
Practice Address - Street 1:1240 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-4463
Practice Address - Country:US
Practice Address - Phone:937-323-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0268831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice