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General NPI Number Information
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NPI Number | 1609968007
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Entity Type | Organization
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Legal Business Name | HAZIM DENTAL CLINIC PC
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12661 SE POWELL BLVD SUITE E
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City | PORTLAND
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State | OR
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Zip | 97236-3400
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Country | US
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Telephone | 503-761-1120
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Fax | 503-774-2622
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Provider Business Mailing Address
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Address Line | PO BOX 90813
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City | PORTLAND
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State | OR
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Zip | 97290-0813
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Country | US
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Telephone | 503-761-1120
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Fax | 503-774-2622
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ZIAD ANTONIOUS HAZIM
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Credential | D.D.S.
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Telephone | 503-761-1120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D7022
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License Number State | OR
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