Provider Demographics
NPI:1215168513
Name:HAWKINS, JEREMIAH J (DMD)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:J
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 68TH STREET
Mailing Address - Street 2:HQS, U.S. ARMY DENTAL ACTIVITY
Mailing Address - City:FT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-5054
Mailing Address - Country:US
Mailing Address - Phone:254-287-2705
Mailing Address - Fax:254-287-1786
Practice Address - Street 1:4431 68TH STREET
Practice Address - Street 2:HQS, U.S. ARMY DENTAL ACTIVITY
Practice Address - City:FT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5054
Practice Address - Country:US
Practice Address - Phone:254-287-2705
Practice Address - Fax:254-287-1786
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist