Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 55670 | CA |
NPI | 1063613842 |
---|---|
Provider Name | Dr. Michael Chad Hawkins |
First Address | Redland, CA 92373 |
Second Address | Riverside, CA 92504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 08/07/2007 |