Provider Demographics
NPI:1538211503
Name:STANIFORTH CALHOUN HAWTHORNE DENTAL OFFICE
Entity type:Organization
Organization Name:STANIFORTH CALHOUN HAWTHORNE DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-232-5401
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:616 FIFTH STREET
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-0848
Mailing Address - Country:US
Mailing Address - Phone:515-232-5401
Mailing Address - Fax:515-233-1804
Practice Address - Street 1:616 FIFTH STREET
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-0848
Practice Address - Country:US
Practice Address - Phone:515-232-5401
Practice Address - Fax:515-233-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty