Provider Demographics
NPI:1972690105
Name:HAWKINS DENTAL GROUP
Entity type:Organization
Organization Name:HAWKINS DENTAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-748-2325
Mailing Address - Street 1:1350 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-2243
Mailing Address - Country:US
Mailing Address - Phone:802-748-2325
Mailing Address - Fax:
Practice Address - Street 1:1350 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2243
Practice Address - Country:US
Practice Address - Phone:802-748-2325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01600004441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008592Medicaid