Provider Demographics
NPI:1639327604
Name:HAZEN, LYNDSEY RAE (DDS)
Entity type:Individual
Prefix:DR
First Name:LYNDSEY
Middle Name:RAE
Last Name:HAZEN
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 1:810 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-3285
Mailing Address - Country:US
Mailing Address - Phone:423-798-1749
Mailing Address - Fax:423-798-1755
Practice Address - Street 1:358 LINDSAY ST # A
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-2412
Practice Address - Country:US
Practice Address - Phone:865-982-6680
Practice Address - Fax:865-984-7536
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011226A122300000X
TN9081122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist