MEDICARE: MICHON LEA HAWKINS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019032359	IL

General Provider Information

NPI Number	:	1841842796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHON LEA HAWKINS DDS

Provider Business Mailing Address
First Line	:	712 COLLEGE ST
Second Line	:
City	:	GREENFIELD
State	:	IL
Zip	:	62044-1414
Country	:	US
Telephone Number	:	217-368-2921
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 COLLEGE ST
Second Line	:
City	:	GREENFIELD
State	:	IL
Zip	:	62044-1414
Country	:	US
Telephone Number	:	217-368-2921
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	10/13/2023

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