Healthcare Provider Details

I. General information

NPI: 1437159084
Provider Name (Legal Business Name): MICHAEL H HAWKINS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 KLAHANIE DR SE
ISSAQUAH WA
98029-5812
US

IV. Provider business mailing address

25962 SE 39TH PL
ISSAQUAH WA
98029-7768
US

V. Phone/Fax

Practice location:
  • Phone: 425-557-8100
  • Fax:
Mailing address:
  • Phone: 425-557-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE00008294
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: