Provider Demographics
NPI:1922016260
Name:HAZEN, HUBERT RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUBERT
Middle Name:RAY
Last Name:HAZEN
Suffix:
Gender:M
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:PO BOX 149
Mailing Address - Street 2:1329 MAIN STREET
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975
Mailing Address - Country:US
Mailing Address - Phone:574-223-3121
Mailing Address - Fax:574-224-2468
Practice Address - Street 1:1329 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975
Practice Address - Country:US
Practice Address - Phone:574-223-3121
Practice Address - Fax:574-224-2468
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007863A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist