Provider Demographics
NPI:1477007300
Name:DAWSON, TWALLA
Entity Type:Individual
Prefix:
First Name:TWALLA
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E 22ND ST
Mailing Address - Street 2:APT 603
Mailing Address - City:CAMERON
Mailing Address - State:TX
Mailing Address - Zip Code:76520-1706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 E 22ND ST
Practice Address - Street 2:APT 603
Practice Address - City:CAMERON
Practice Address - State:TX
Practice Address - Zip Code:76520-1706
Practice Address - Country:US
Practice Address - Phone:254-288-5573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37637126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant