Provider Demographics
NPI:1417151929
Name:HAWKEY, CYNTHIA M (RDH)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:HAWKEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:COUGHLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:314 E MCPHERSON ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-3557
Mailing Address - Country:US
Mailing Address - Phone:660-627-5757
Mailing Address - Fax:660-627-5802
Practice Address - Street 1:302 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-3416
Practice Address - Country:US
Practice Address - Phone:660-626-2741
Practice Address - Fax:660-626-2188
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007016225124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507477404Medicaid