Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2901011774 | MI |
NPI | 1023104486 |
---|---|
Provider Name | Thomas N Hawkins JR. |
First Address | Norfolk, VA 23511-2803 |
Second Address | Norfolk, VA 23511-2803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |