Provider Demographics
NPI:1104052638
Name:HAWKINS, JEREMY L (DDS, PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:L
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:DDS, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 929
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27289-0929
Mailing Address - Country:US
Mailing Address - Phone:336-623-9143
Mailing Address - Fax:336-627-0948
Practice Address - Street 1:113 W ARBOR LN
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5305
Practice Address - Country:US
Practice Address - Phone:336-623-9143
Practice Address - Fax:336-627-0948
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16461183500000X
NC14271122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No183500000XPharmacy Service ProvidersPharmacist