Healthcare Provider Details

I. General information

NPI: 1548434459
Provider Name (Legal Business Name): LEWIS & HAWN EXCELLENCE IN DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 PINE ST
SANDPOINT ID
83864-9327
US

IV. Provider business mailing address

2025 PINE ST
SANDPOINT ID
83864-9327
US

V. Phone/Fax

Practice location:
  • Phone: 208-265-4558
  • Fax:
Mailing address:
  • Phone: 208-265-4558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MARK W HAWN
Title or Position: PRESIDENT
Credential: DDS
Phone: 208-265-4558