Healthcare Provider Details

I. General information

NPI: 1699925859
Provider Name (Legal Business Name): KIRK G HAWN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 E. BROADWAY ST
LOVETTSVILLE VA
20180
US

IV. Provider business mailing address

PO BOX 319
LOVETTSVILLE VA
20180
US

V. Phone/Fax

Practice location:
  • Phone: 540-822-5446
  • Fax: 540-822-9333
Mailing address:
  • Phone: 540-822-5446
  • Fax: 540-822-9333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401006795
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: