Provider Demographics
NPI:1720695323
Name:HAWKES, CODY (DDS)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:HAWKES
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:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-0065
Mailing Address - Country:US
Mailing Address - Phone:517-849-9195
Mailing Address - Fax:
Practice Address - Street 1:211 HARLEY ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-1195
Practice Address - Country:US
Practice Address - Phone:517-849-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016007021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice