Provider Demographics
NPI:1144415209
Name:ADUGNA, DAWIT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAWIT
Middle Name:
Last Name:ADUGNA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9036 TIMBERLIN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-5431
Mailing Address - Country:US
Mailing Address - Phone:951-536-2200
Mailing Address - Fax:
Practice Address - Street 1:5000 US HWY. 17 S.
Practice Address - Street 2:SUITE 4
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:951-536-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014119121223G0001X
AZ76991223G0001X
FLDN 196461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice