Provider Demographics
NPI:1568245322
Name:HAWKINS, ANGELA MARGARET
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARGARET
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 BROOKSIDE DR E
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-3248
Mailing Address - Country:US
Mailing Address - Phone:517-902-8676
Mailing Address - Fax:
Practice Address - Street 1:2353 S CUSTER RD STE 1
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-5047
Practice Address - Country:US
Practice Address - Phone:734-241-4855
Practice Address - Fax:734-241-4875
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902012394124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist