Provider Demographics
NPI:1700974110
Name:HAWTHORN, CHRIS DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:DALE
Last Name:HAWTHORN
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 1:120 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-3334
Mailing Address - Country:US
Mailing Address - Phone:918-225-5032
Mailing Address - Fax:
Practice Address - Street 1:120 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-3334
Practice Address - Country:US
Practice Address - Phone:918-225-5032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice