Provider Demographics
NPI:1003108820
Name:FAWSON, PAUL CLARK III (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CLARK
Last Name:FAWSON
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2204 E 29H AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-3961
Mailing Address - Country:US
Mailing Address - Phone:509-535-9515
Mailing Address - Fax:509-535-9525
Practice Address - Street 1:2204 E 29H AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-3961
Practice Address - Country:US
Practice Address - Phone:509-535-9515
Practice Address - Fax:509-535-9525
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT24581223G0001X
WADE602919461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice