Provider Demographics
NPI:1477234920
Name:HAWK, KAITLYN LINDSAY (RDH, MED)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:LINDSAY
Last Name:HAWK
Suffix:
Gender:F
Credentials:RDH, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 LAKELSE LN
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5841
Mailing Address - Country:US
Mailing Address - Phone:509-396-4755
Mailing Address - Fax:
Practice Address - Street 1:940 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3505
Practice Address - Country:US
Practice Address - Phone:509-542-4571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60511001124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist