Healthcare Provider Details

I. General information

NPI: 1174814156
Provider Name (Legal Business Name): H & K DENTAL SERVICES ,PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129B N MAIN ST
FAIR HAVEN VT
05743-1132
US

IV. Provider business mailing address

PO BOX 37
FAIR HAVEN VT
05743-0037
US

V. Phone/Fax

Practice location:
  • Phone: 802-265-3604
  • Fax: 802-251-0022
Mailing address:
  • Phone: 802-265-3604
  • Fax: 802-251-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. FADI JAMIL HAWWASH
Title or Position: OWNER
Credential: DMD
Phone: 802-265-3604