Provider Demographics
NPI:1396265187
Name:HAWKS, CORBIN MICHAEL (DMD)
Entity type:Individual
Prefix:
First Name:CORBIN
Middle Name:MICHAEL
Last Name:HAWKS
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 1:1201 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH FULTON
Mailing Address - State:TN
Mailing Address - Zip Code:38257-2700
Mailing Address - Country:US
Mailing Address - Phone:731-479-3445
Mailing Address - Fax:731-479-3447
Practice Address - Street 1:236 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1604
Practice Address - Country:US
Practice Address - Phone:270-247-7173
Practice Address - Fax:270-247-7174
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN105461223G0001X
KY99281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice