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General NPI Number Information
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NPI Number | 1902876824
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Entity Type | Individual
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Provider Name | JERALD BRIAN HAWK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 1750 ROCKVILLE PIKE STE 22
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City | ROCKVILLE
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State | MD
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Zip | 20852-1658
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Country | US
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Telephone | 301-230-2600
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Fax | 301-231-6592
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Provider Business Mailing Address
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Address Line | 819 BROMLEY ST
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City | SILVER SPRING
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State | MD
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Zip | 20902-3019
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Country | US
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Telephone | 301-452-0185
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 12910
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License Number State | MD
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