Individual
BRANDON HAZELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1029 RESERVOIR AVE, CRANSTON, RI 02910-5134
(401) 943-1234
Mailing address
1029 RESERVOIR AVE, CRANSTON, RI 02910-5134
(401) 943-1234
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN03560
RI
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Enumeration date
03/08/2021
Last updated
07/27/2022
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