Provider Demographics
NPI:1497064257
Name:DAWSON, KATIE LAVERNE (RDH)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:LAVERNE
Last Name:DAWSON
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 1:295 LENOX AVE
Mailing Address - Street 2:APT. 302
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4659
Mailing Address - Country:US
Mailing Address - Phone:510-444-1354
Mailing Address - Fax:510-763-3452
Practice Address - Street 1:295 LENOX AVE
Practice Address - Street 2:APT. 302
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4659
Practice Address - Country:US
Practice Address - Phone:510-444-1354
Practice Address - Fax:510-763-3452
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301124Q00000X
CA7053124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist