Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 12010157 | IN |
NPI | 1053442327 |
---|---|
Provider Name | Dr. Chad Owen Hazelrigg |
First Address | Noblesville, IN 46060-1307 |
Second Address | Noblesville, IN 46060-1307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
163440 | CSHCS (01) | IN |