Individual
DR. TYLER STEPHEN HAWTHORNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
205 N HOOD ST, LAKE PROVIDENCE, LA 71254-2103
(318) 559-1034
Mailing address
115 EDINBURG DR, WEST MONROE, LA 71291-7656
(318) 355-4503
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7125
LA
Other
Enumeration date
07/20/2020
Last updated
07/20/2020
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