Provider Demographics
NPI:1144375940
Name:HAWLEY, MALCOLM EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:EDWARD
Last Name:HAWLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W MORSE BLVD
Mailing Address - Street 2:SUITE #3-C
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3797
Mailing Address - Country:US
Mailing Address - Phone:407-647-8384
Mailing Address - Fax:
Practice Address - Street 1:800 W MORSE BLVD
Practice Address - Street 2:SUITE #3-C
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3797
Practice Address - Country:US
Practice Address - Phone:407-647-8384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3955122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist