Provider Demographics
NPI:1053984930
Name:HAWORTH, NATALIE NICHOLE (RDH)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:NICHOLE
Last Name:HAWORTH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 STONEGATE ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-5803
Mailing Address - Country:US
Mailing Address - Phone:580-515-2046
Mailing Address - Fax:
Practice Address - Street 1:10321 N 2274 RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-7521
Practice Address - Country:US
Practice Address - Phone:580-323-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4401124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist