Provider Demographics
NPI:1538261961
Name:HAZELWOOD, GEORGE FRED III (DDS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:FRED
Last Name:HAZELWOOD
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:G
Other - Middle Name:FRED
Other - Last Name:HAZELWOOD
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:736 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1615
Mailing Address - Country:US
Mailing Address - Phone:301-334-9288
Mailing Address - Fax:301-334-5471
Practice Address - Street 1:736 E OAK ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1615
Practice Address - Country:US
Practice Address - Phone:301-334-9288
Practice Address - Fax:301-334-5471
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD8301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3264OtherBLUE CROSS BLUE SHIELD
34571OtherUNITED HEALTH CARE
D103088OtherCIGNA
296936OtherMAMSI
850897OtherUNITED CONCORDIA