=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477321453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAWKINS FAMILY DENTISTRY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2023
-----------------------------------------------------
Last Update Date | 12/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 609 WASHINGTON BLVD
-----------------------------------------------------
City | BELPRE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45714-2464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-423-8416
-----------------------------------------------------
Fax | 740-423-8424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 609 WASHINGTON BLVD
-----------------------------------------------------
City | BELPRE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45714-2464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-423-8416
-----------------------------------------------------
Fax | 740-423-8424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. LORI A HAWKINS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 740-423-8416
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------