Tyler Stephen Hawthorne, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7125 Issued in LA

Practice address

205 N Hood St
Lake Providence, LA 71254-2103

Phone

(318) 559-1034

NPI assigned

Jul 20, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595203200000",
    "number": "1730797341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 EDINBURG DR",
            "city": "WEST MONROE",
            "state": "LA",
            "postal_code": "712917656",
            "telephone_number": "318-355-4503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N HOOD ST",
            "city": "LAKE PROVIDENCE",
            "state": "LA",
            "postal_code": "712542103",
            "telephone_number": "318-559-1034"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "164 Country Club Cir",
            "address_purpose": "LOCATION",
            "city": "Minden",
            "state": "LA",
            "postal_code": "710557502",
            "country_code": "US",
            "telephone_number": "318-639-9559",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "502 Ross St",
            "address_purpose": "LOCATION",
            "city": "Oak Grove",
            "state": "LA",
            "postal_code": "712639706",
            "country_code": "US",
            "telephone_number": "318-428-2358",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAWTHORNE",
        "first_name": "TYLER",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-20",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "7125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Lake Providence, LA
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.