Provider Demographics
NPI:1063613842
Name:HAWKINS, MICHAEL CHAD (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHAD
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 S BUENA VISTA,
Mailing Address - Street 2:
Mailing Address - City:REDLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92373
Mailing Address - Country:US
Mailing Address - Phone:951-751-9839
Mailing Address - Fax:
Practice Address - Street 1:3511 MADISON AVE SUITE F
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504
Practice Address - Country:US
Practice Address - Phone:951-688-6794
Practice Address - Fax:951-689-8969
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics