Organization
MOUNTAINEER ORTHODONTICS, PLLC
Active
Organization
MOUNTAINEER ORTHODONTICS, PLLC
Active
Other names
Drs. Lacy, Weidman & Hazey III, Drs. Weidman and Hazey III, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL A HAZEY III D.D.S., M.S. (OWNER)
(304) 842-5211
Entity
Organization
Contact information
Practice address
112 HILL ST, BRIDGEPORT, WV 26330-1756
(304) 842-5211
(304) 842-1163
Mailing address
112 HILL ST, BRIDGEPORT, WV 26330-1756
(304) 842-5211
(304) 842-1163
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2285
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
163-924-6887
NPI NUMBER
WV
01
—
165-944-8991
NPI NUMBER
WV
01
—
177-065-0012
NPI NUMBER
WV
Enumeration date
04/25/2007
Last updated
09/12/2025
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