Healthcare Provider Details

I. General information

NPI: 1467461020
Provider Name (Legal Business Name): MARK A HAWKINS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3247 N ASHLAND AVE
CHICAGO IL
60657-2129
US

IV. Provider business mailing address

3247 N ASHLAND AVE
CHICAGO IL
60657-2129
US

V. Phone/Fax

Practice location:
  • Phone: 773-281-8320
  • Fax: 773-281-6996
Mailing address:
  • Phone: 773-281-8320
  • Fax: 773-281-6996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: