Provider Demographics
NPI:1861409211
Name:HAWKINS, JEFFREY TODD (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TODD
Last Name:HAWKINS
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 1:2820 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-6220
Mailing Address - Country:US
Mailing Address - Phone:941-926-4800
Mailing Address - Fax:630-972-1050
Practice Address - Street 1:2820 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6220
Practice Address - Country:US
Practice Address - Phone:419-264-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190247191223P0106X
NC136151223S0112X
FLDN210031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology