MEDICARE: H & K DENTAL SERVICES ,PLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1174814156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H & K DENTAL SERVICES ,PLC

Provider Business Mailing Address
First Line	:	PO BOX 37
Second Line	:
City	:	FAIR HAVEN
State	:	VT
Zip	:	05743-0037
Country	:	US
Telephone Number	:	802-265-3604
Fax Number	:	802-251-0022

Provider Business Practice Location Address
First Line	:	129B N MAIN ST
Second Line	:
City	:	FAIR HAVEN
State	:	VT
Zip	:	05743-1132
Country	:	US
Telephone Number	:	802-265-3604
Fax Number	:	802-251-0022

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FADI JAMIL HAWWASH
Credential	:	DMD
Telephone Number	:	802-265-3604

Provider Enumeration Date	:	04/26/2011
Last Update Date	:	04/26/2011

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