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General NPI Number Information
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NPI Number | 1861409211
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Entity Type | Individual
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Provider Name | JEFFREY TODD HAWKINS DDS
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 2820 CLARK RD
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City | SARASOTA
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State | FL
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Zip | 34231-6220
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Country | US
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Telephone | 419-264-8009
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Fax |
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Provider Business Mailing Address
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Address Line | 2820 CLARK RD
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City | SARASOTA
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State | FL
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Zip | 34231-6220
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Country | US
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Telephone | 941-926-4800
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Fax | 630-972-1050
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 019024719
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 13615
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN21003
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License Number State | FL
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