Provider Demographics
NPI:1093567075
Name:SOUTHERLY, DAWN PARTLOW (RDH)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:PARTLOW
Last Name:SOUTHERLY
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 1:170 THURSTON CT
Mailing Address - Street 2:
Mailing Address - City:CLEAR BROOK
Mailing Address - State:VA
Mailing Address - Zip Code:22624-1673
Mailing Address - Country:US
Mailing Address - Phone:703-969-1360
Mailing Address - Fax:
Practice Address - Street 1:173 SKIRMISHER LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:VA
Practice Address - Zip Code:22645-1745
Practice Address - Country:US
Practice Address - Phone:703-969-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402001943124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist