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NPI Code Detail

MEDICARE: DR. GARY ALLEN HAWTHORNE D.M.D.

MEDICARE:  DR. GARY ALLEN HAWTHORNE  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
11223G0001XGeneral Practice Dentistry2783AR

General Provider Information

NPI Number : 1952412850
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY ALLEN HAWTHORNE D.M.D.
Provider Business Mailing Address
First Line : 1803 S GREENWOOD AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-5821
Country : US
Telephone Number : 479-782-2487
Fax Number : 479-782-8838
Provider Business Practice Location Address
First Line : 1803 S GREENWOOD AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-5821
Country : US
Telephone Number : 479-782-2487
Fax Number : 479-782-8838
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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Directions to “ DR. GARY ALLEN HAWTHORNE D.M.D.” Practice Location

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