Provider Demographics
NPI:1003073511
Name:DAWSON, BRAD J (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:J
Last Name:DAWSON
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:702 BARNHILL DR
Mailing Address - Street 2:SUITE 4205
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5128
Mailing Address - Country:US
Mailing Address - Phone:317-278-4238
Mailing Address - Fax:317-278-0760
Practice Address - Street 1:1597 WOODLAND PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041
Practice Address - Country:US
Practice Address - Phone:801-544-1940
Practice Address - Fax:801-896-0645
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2018-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT34938899221223X0400X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics