Provider Demographics
NPI:1720193154
Name:RAWSON, RICK JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:JAMES
Last Name:RAWSON
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 1:5420 KIETZKE LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3022
Mailing Address - Country:US
Mailing Address - Phone:775-853-9696
Mailing Address - Fax:775-853-9695
Practice Address - Street 1:5420 KIETZKE LN
Practice Address - Street 2:SUITE 102
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3022
Practice Address - Country:US
Practice Address - Phone:775-853-9696
Practice Address - Fax:775-853-9695
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS2-95C1223S0112X
CA503541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery