MEDICARE: DR. MICHAEL C HAZEL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5121	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033111216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL C HAZEL DMD

Provider Business Mailing Address
First Line	:	18607 WILLAMETTE DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-1705
Country	:	US
Telephone Number	:	503-635-3588
Fax Number	:	503-635-3909

Provider Business Practice Location Address
First Line	:	18607 WILLAMETTE DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-1705
Country	:	US
Telephone Number	:	503-635-3588
Fax Number	:	503-635-3909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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