Provider Demographics
NPI:1790976421
Name:LAWSON, JESSICA LK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LK
Last Name:LAWSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 NORTHWEST 128TH STREET
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-1728
Mailing Address - Country:US
Mailing Address - Phone:515-278-4366
Mailing Address - Fax:515-278-4624
Practice Address - Street 1:4444 NORTHWEST 128TH STREET
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50323-1728
Practice Address - Country:US
Practice Address - Phone:515-278-4366
Practice Address - Fax:515-278-4624
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08512122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0400149Medicaid