Provider Demographics
NPI:1447601547
Name:DAWSON, TERRENCE TERRELL
Entity Type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:TERRELL
Last Name:DAWSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5584 MAPLE PARK DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3915
Mailing Address - Country:US
Mailing Address - Phone:810-835-8818
Mailing Address - Fax:
Practice Address - Street 1:5584 MAPLE PARK DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3915
Practice Address - Country:US
Practice Address - Phone:810-835-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other