Provider Demographics
NPI:1508285552
Name:HAWES, NATHAN M (DMD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:M
Last Name:HAWES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 PROGRESSIVE PKWY
Mailing Address - Street 2:PO BOX 501
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-0501
Mailing Address - Country:US
Mailing Address - Phone:608-348-9591
Mailing Address - Fax:
Practice Address - Street 1:1721 PROGRESSIVE PKWY
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-0501
Practice Address - Country:US
Practice Address - Phone:608-348-9591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100189-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice