Provider Demographics
NPI:1578776456
Name:MATHEWS, DAWSON KENDRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAWSON
Middle Name:KENDRICK
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 KNOXVILLE ST
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-4251
Mailing Address - Country:US
Mailing Address - Phone:478-825-3315
Mailing Address - Fax:
Practice Address - Street 1:302 KNOXVILLE ST
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-4251
Practice Address - Country:US
Practice Address - Phone:478-825-3315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0082831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice