Healthcare Provider Details

I. General information

NPI: 1841307055
Provider Name (Legal Business Name): JAMES CUMMINS HAZLETT III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 CLARK RD E3
SARASOTA FL
34233
US

IV. Provider business mailing address

3900 CLARK RD E3
SARASOTA FL
34233
US

V. Phone/Fax

Practice location:
  • Phone: 941-922-0671
  • Fax: 941-924-0579
Mailing address:
  • Phone: 941-922-0671
  • Fax: 941-924-0579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN15028
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: