Provider Demographics
NPI:1255478194
Name:HAWKINS, LORI ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-1616
Mailing Address - Country:US
Mailing Address - Phone:740-423-8416
Mailing Address - Fax:740-423-8424
Practice Address - Street 1:400 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1616
Practice Address - Country:US
Practice Address - Phone:740-423-8416
Practice Address - Fax:740-423-8424
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0210841223G0001X
WV34361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3436OtherWV DENTAL LICENSE
OH30-021084OtherOHIO DENTAL LICENSE