Provider Demographics
NPI:1912902172
Name:HAWK, KENNETH A (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:HAWK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2841
Mailing Address - Country:US
Mailing Address - Phone:541-484-2007
Mailing Address - Fax:541-484-0419
Practice Address - Street 1:1999 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2841
Practice Address - Country:US
Practice Address - Phone:541-484-2007
Practice Address - Fax:541-484-0419
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD47281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice