Brent Michael Hazlewood, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

2901021193 Issued in MI

Practice address

12662 Riley St Ste 130
Holland, MI 49424-8023

Phone

(616) 399-6811

Fax

(616) 399-6812

NPI assigned

Jul 28, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1406505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1851709331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12662 RILEY ST STE 130",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494248023",
            "telephone_number": "616-399-6811",
            "fax_number": "616-399-6812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12662 RILEY ST STE 130",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494248023",
            "telephone_number": "616-399-6811",
            "fax_number": "616-399-6812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAZLEWOOD",
        "first_name": "BRENT",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-28",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "MI",
            "license": "2901021193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Francois Harton, DPM
• Mary Louise Hasenauer, N.P.
• Rissa Joy Hasina, LMSW
• Danielle Hawkes
• Casey Hayes
• HCH Home Health Care Corporation
• Healthzone Chiropractic 4 PC
• Heartland of Holland Mi LLC
• Erin Heavilin
• Ann Marie Heerde, LMSW

• Endodontics in Holland, MI
• Providers in Holland, MI by specialty
• Endodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.