Provider Demographics
NPI:1497043566
Name:HAWK, CARRIE ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ANNE
Last Name:HAWK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 PGA BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-7095
Mailing Address - Country:US
Mailing Address - Phone:330-934-0128
Mailing Address - Fax:330-343-5221
Practice Address - Street 1:139 FAIR AVE NE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-2827
Practice Address - Country:US
Practice Address - Phone:330-343-5221
Practice Address - Fax:330-343-5221
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300235351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice