Provider Demographics
NPI:1235349887
Name:HAWKINS, KENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:
Last Name:HAWKINS
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 1:1051 LYDIA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-7081
Mailing Address - Country:US
Mailing Address - Phone:614-642-0040
Mailing Address - Fax:
Practice Address - Street 1:1051 LYDIA DR STE 200
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-7081
Practice Address - Country:US
Practice Address - Phone:937-642-0040
Practice Address - Fax:937-644-0060
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300219101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2501644Medicaid