Provider Demographics
NPI:1700954047
Name:HAWKSFORD-LARSON DENTAL CARE, LLC
Entity Type:Organization
Organization Name:HAWKSFORD-LARSON DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAWKSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-634-6776
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:15541 HIGHWAY 77E
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843
Mailing Address - Country:US
Mailing Address - Phone:715-634-6776
Mailing Address - Fax:715-634-5859
Practice Address - Street 1:15541W HIGHWAY 77 E
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843
Practice Address - Country:US
Practice Address - Phone:715-634-6776
Practice Address - Fax:715-634-5859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty