Provider Demographics
NPI:1629534326
Name:LAWSON, BRIAN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:LAWSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-7056
Mailing Address - Country:US
Mailing Address - Phone:585-760-4128
Mailing Address - Fax:
Practice Address - Street 1:600 HILL AVE STE 1
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-4713
Practice Address - Country:US
Practice Address - Phone:615-329-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN110131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program