David Mark Hazzouri Sr., DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DS027711L Issued in PA

Practice address

211 S. 7TH Ave.
Scranton, PA 18505

Phone

(570) 961-6030

Fax

(570) 961-6030

NPI assigned

Aug 5, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2025 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Reconstructive Dentistry, LLC

  • Ambulatory Surgical Clinic/Center
  • Scranton, PA
  • NPI 1588019095
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1265623417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 S. 7TH AVE.",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "18505",
            "telephone_number": "570-961-6030",
            "fax_number": "570-961-6030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S. 7TH AVE.",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "18505",
            "telephone_number": "570-961-6030",
            "fax_number": "570-961-6030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAZZOURI",
        "first_name": "DAVID",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-05",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "PA",
            "license": "DS027711L",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS027711L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Lynn Hartman, PHD, LPC, ATR-BC
• John R. Harvey, PH.D.
• Kristen Marie Haskell
• Mariah Frances Hawley
• Albert A Hazzouri, D.D.S,M.S.
• Lauren Elizabeth Hazzouri, PSYD
• Michele A Hazzouri, M.D.
• Arthur Heal, CRNA
• Georgia Ann Healey, PA-C
• Sara Rupp Heard, PHARM.D., RPH

• Dentist in Scranton, PA
• Providers in Scranton, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.