Individual
DR. HAZEL E MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4536 22ND AVE, KENOSHA, WI 53140-5917
(262) 656-0044
(262) 653-2218
Mailing address
5822 CHARLES ST, RACINE, WI 53402-1824
(262) 681-2085
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3267-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33462500
—
WI
Enumeration date
10/04/2005
Last updated
12/29/2011
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