Provider Demographics
NPI:1558994582
Name:RAWSON PEDIATRIC DENTAL GROUP
Entity Type:Organization
Organization Name:RAWSON PEDIATRIC DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY MAE
Authorized Official - Middle Name:NAVARRO
Authorized Official - Last Name:RAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-888-3520
Mailing Address - Street 1:4620 JEFFERSON LN NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2149
Mailing Address - Country:US
Mailing Address - Phone:505-888-3520
Mailing Address - Fax:
Practice Address - Street 1:4620 JEFFERSON LN NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2149
Practice Address - Country:US
Practice Address - Phone:505-888-3520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty