Provider Demographics
NPI:1790966836
Name:DAWSON AND DAWSON FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DAWSON AND DAWSON FAMILY DENTISTRY
Other - Org Name:DAWSON AND DAWSON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-393-2456
Mailing Address - Street 1:520 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532
Mailing Address - Country:US
Mailing Address - Phone:843-393-2456
Mailing Address - Fax:
Practice Address - Street 1:520 S. MAIN ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532
Practice Address - Country:US
Practice Address - Phone:843-393-2456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ22485Medicaid