Provider Demographics
NPI:1306278197
Name:HAWK, ELISE C (DDS)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:C
Last Name:HAWK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:C
Other - Last Name:SCICLUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3210 NAVARRE RD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-4880
Mailing Address - Country:US
Mailing Address - Phone:307-331-0845
Mailing Address - Fax:
Practice Address - Street 1:1201 S ELK ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-4009
Practice Address - Country:US
Practice Address - Phone:307-234-3890
Practice Address - Fax:307-472-5583
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1350122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist