Provider Demographics
NPI:1265542054
Name:HAWKINS, BRETT GARRETT (DDS)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:GARRETT
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 E SOUTHERN AVE
Mailing Address - Street 2:#5
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-831-3898
Mailing Address - Fax:480-831-9352
Practice Address - Street 1:1628 E SOUTHERN AVE
Practice Address - Street 2:#5
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-831-3898
Practice Address - Fax:480-831-9352
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice