Organization
MOUNTAINEER ORTHODONTICS, PLLC
Active
Other names
Drs. Lacy, Weidman & Hazey III, Drs. Lacy, Weidman & Hazey III, PLLC, 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) 598-2500
Entity
Organization
Contact information
Practice address
918 CHESTNUT RIDGE PROF. BLDG., SUITE #5, MORGANTOWN, WV 26505-2822
(304) 598-2500
(304) 598-2517
Mailing address
918 CHESTNUT RIDGE PROF. BLDG., SUITE #5, MORGANTOWN, WV 26505-2822
(304) 598-2500
(304) 598-2517
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
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
04/27/2007
Last updated
09/15/2025
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