Provider Demographics
NPI:1841842796
Name:HAWKINS, MICHON LEA (DDS)
Entity type:Individual
Prefix:
First Name:MICHON
Middle Name:LEA
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MICHON
Other - Middle Name:LEA
Other - Last Name:RYLANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:712 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62044-1414
Mailing Address - Country:US
Mailing Address - Phone:217-368-2921
Mailing Address - Fax:
Practice Address - Street 1:712 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IL
Practice Address - Zip Code:62044-1414
Practice Address - Country:US
Practice Address - Phone:217-368-2921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190323591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice