Provider Demographics
NPI:1356560346
Name:DRS. WEIDMAN & HAZEY III, PLLC
Entity type:Organization
Organization Name:DRS. WEIDMAN & HAZEY III, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAZEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:304-842-5211
Mailing Address - Street 1:112 HILL ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1756
Mailing Address - Country:US
Mailing Address - Phone:304-842-5211
Mailing Address - Fax:304-842-1163
Practice Address - Street 1:112 HILL ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1756
Practice Address - Country:US
Practice Address - Phone:304-842-5211
Practice Address - Fax:304-842-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV177-065-0012OtherNPI NUMBER
WV163-924-6887OtherNPI NUMBER
WV165-944-8991OtherNPI NUMBER