Provider Demographics
NPI:1265623417
Name:HAZZOURI, DAVID MARK SR (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK
Last Name:HAZZOURI
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S. 7TH AVE.
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505
Mailing Address - Country:US
Mailing Address - Phone:570-961-6030
Mailing Address - Fax:570-961-6030
Practice Address - Street 1:211 S. 7TH AVE.
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505
Practice Address - Country:US
Practice Address - Phone:570-961-6030
Practice Address - Fax:570-961-6030
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027711L1223P0700X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics