Provider Demographics
NPI:1093163479
Name:HAWKINS HEIGHTS DENTAL
Entity Type:Organization
Organization Name:HAWKINS HEIGHTS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MORGESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:636-225-5600
Mailing Address - Street 1:2578 GLADIATOR DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2285
Mailing Address - Country:US
Mailing Address - Phone:636-225-5600
Mailing Address - Fax:636-225-5601
Practice Address - Street 1:2578 GLADIATOR DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2285
Practice Address - Country:US
Practice Address - Phone:636-225-5600
Practice Address - Fax:636-225-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty