Provider Demographics
NPI:1295255438
Name:HAZARD, MIKAELA LEIGH I (DDS)
Entity type:Individual
Prefix:DR
First Name:MIKAELA
Middle Name:LEIGH
Last Name:HAZARD
Suffix:I
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 1:2910 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6032
Mailing Address - Country:US
Mailing Address - Phone:701-212-1206
Mailing Address - Fax:701-280-2614
Practice Address - Street 1:2910 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6032
Practice Address - Country:US
Practice Address - Phone:701-212-1206
Practice Address - Fax:701-280-2614
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND23791223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics