Provider Demographics
NPI:1114188745
Name:HAWK, NATHAN JEROD (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JEROD
Last Name:HAWK
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 1:10740 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7982
Mailing Address - Country:US
Mailing Address - Phone:317-271-3079
Mailing Address - Fax:
Practice Address - Street 1:10740 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7982
Practice Address - Country:US
Practice Address - Phone:317-271-3079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120111851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice