Individual
BRANDIE HAZELTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5415 NE 54TH AVE, VANCOUVER, WA 98661-2165
(360) 609-4170
Mailing address
5415 NE 54TH AVENUE, VANCOUVER, WA 98661
(360) 609-4170
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
93-0798039
WA
Other
Enumeration date
11/29/2012
Last updated
11/29/2012
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