Provider Demographics
NPI:1518571538
Name:THAYNE DAWSON DMD LLC
Entity Type:Organization
Organization Name:THAYNE DAWSON DMD LLC
Other - Org Name:NORTHWIND DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THAYNE
Authorized Official - Middle Name:JORAY
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-707-9421
Mailing Address - Street 1:6110 N TALGACH VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-9044
Mailing Address - Country:US
Mailing Address - Phone:208-351-6538
Mailing Address - Fax:907-373-1920
Practice Address - Street 1:3719 E MERIDIAN LOOP STE B
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7273
Practice Address - Country:US
Practice Address - Phone:907-373-2440
Practice Address - Fax:907-373-1920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental