Provider Demographics
NPI:1568891604
Name:D. JEANETTE LAWSON, DDS, PC
Entity Type:Organization
Organization Name:D. JEANETTE LAWSON, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-770-4783
Mailing Address - Street 1:15887 CUMBERLAND RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4329
Mailing Address - Country:US
Mailing Address - Phone:317-770-4783
Mailing Address - Fax:317-770-4785
Practice Address - Street 1:15887 CUMBERLAND RD
Practice Address - Street 2:SUITE 104
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4329
Practice Address - Country:US
Practice Address - Phone:317-770-4783
Practice Address - Fax:317-770-4785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007812A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1669421582Medicaid