1861729618 NPI number — NATHAN HAWK, D.M.D, P.C.

Table of content: DUSTIN JAMES SEPICH M.D. (NPI 1801109152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861729618 NPI number — NATHAN HAWK, D.M.D, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATHAN HAWK, D.M.D, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861729618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 S MEMORIAL DR
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
NEW CASTLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47362-4988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-529-8668
Provider Business Mailing Address Fax Number:
765-529-8778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 S MEMORIAL DR
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47362-4988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-529-8668
Provider Business Practice Location Address Fax Number:
765-529-8778
Provider Enumeration Date:
11/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HAWK
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
765-529-8668

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12011185B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1114188745 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com