Provider Demographics
NPI:1346946548
Name:JENNY O. HAWKINS DDS PC
Entity Type:Organization
Organization Name:JENNY O. HAWKINS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-925-7829
Mailing Address - Street 1:22749 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-6305
Mailing Address - Country:US
Mailing Address - Phone:301-862-8822
Mailing Address - Fax:
Practice Address - Street 1:22749 MAPLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-6305
Practice Address - Country:US
Practice Address - Phone:301-863-8822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1508004318Medicaid
MD1013164466Medicaid
MD1013536051Medicaid
MD1740289685Medicaid