Provider Demographics
NPI:1932290723
Name:HARES, HAZAMI A (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAZAMI
Middle Name:A
Last Name:HARES
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 1:8721 JOSEPH CAMPAU ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3720
Mailing Address - Country:US
Mailing Address - Phone:313-871-2222
Mailing Address - Fax:313-871-2084
Practice Address - Street 1:8721 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3720
Practice Address - Country:US
Practice Address - Phone:313-871-2222
Practice Address - Fax:313-871-2084
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010159891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1319966OtherUNITED CONCORDIA
MI4317432Medicaid