Provider Demographics
NPI:1659415958
Name:DAWSON, LELAND BRADLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:BRADLEY
Last Name:DAWSON
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 1:13210 SE 240TH ST
Mailing Address - Street 2:SUITE B1
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5182
Mailing Address - Country:US
Mailing Address - Phone:253-631-8490
Mailing Address - Fax:253-639-3929
Practice Address - Street 1:13210 SE 240TH ST
Practice Address - Street 2:SUITE B1
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-5182
Practice Address - Country:US
Practice Address - Phone:253-631-8490
Practice Address - Fax:253-639-3929
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA48631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice