Provider Demographics
NPI:1942462296
Name:MACANIP, HAZEL (DDS)
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:
Last Name:MACANIP
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 1:441 N WEBER RD
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-3972
Mailing Address - Country:US
Mailing Address - Phone:815-372-0100
Mailing Address - Fax:815-372-0300
Practice Address - Street 1:441 N WEBER RD
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-3972
Practice Address - Country:US
Practice Address - Phone:815-372-0100
Practice Address - Fax:815-372-0300
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILJ19-0256201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice