Provider Demographics
NPI:1184938755
Name:HAWKEYE FAMILY DENTAL
Entity type:Organization
Organization Name:HAWKEYE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROCKY
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-338-7172
Mailing Address - Street 1:220 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WAPELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52653-1202
Mailing Address - Country:US
Mailing Address - Phone:319-527-6421
Mailing Address - Fax:319-527-6422
Practice Address - Street 1:1705 S 1ST AVE STE P
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6037
Practice Address - Country:US
Practice Address - Phone:319-338-7172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty