Emily Renk Hawthorne, D.D.S.
Individual provider Active NPI Dentist · Nipomo, CA
NPI 1306193560 · NPPES record last updated May 31, 2021
Key facts
- NPI
- 1306193560
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 61690 (CA)
- Practice address
- 150 Tejas PL
Nipomo, CA 93444-9123 - Phone
- (805) 929-3211
- NPI assigned
- Aug 7, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160630000384 | CA | Order and Referring Only - Dentist |
5890087423 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61690 | CA | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 61690 | CA | Yes |
Addresses
Primary practice location
150 Tejas PL
Nipomo, CA 93444-9123
Mailing address
2950 Hawk Hill LN
San Luis Obispo, CA 93405-8328
Phone (714) 309-6556
Other providers in Nipomo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.