Healthcare Provider Details

I. General information

NPI: 1861409211
Provider Name (Legal Business Name): JEFFREY TODD HAWKINS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 CLARK RD
SARASOTA FL
34231-6220
US

IV. Provider business mailing address

2820 CLARK RD
SARASOTA FL
34231-6220
US

V. Phone/Fax

Practice location:
  • Phone: 419-264-8009
  • Fax:
Mailing address:
  • Phone: 941-926-4800
  • Fax: 630-972-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number019024719
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number13615
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN21003
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: