MEDICARE: DR. BRENT J HAWKES D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D008975	AZ

General Provider Information

NPI Number	:	1144633793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT J HAWKES D.M.D

Provider Business Mailing Address
First Line	:	3003 HWAY 95 STE 15
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7896
Country	:	US
Telephone Number	:	928-758-4664
Fax Number	:	928-758-2645

Provider Business Practice Location Address
First Line	:	3003 HWAY 95 STE 15
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7896
Country	:	US
Telephone Number	:	928-758-4664
Fax Number	:	928-758-2645

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2014
Last Update Date	:	06/10/2014

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