Provider Demographics
NPI:1891875118
Name:DAWKINS FAMILY DENTAL CLINIC PA
Entity Type:Organization
Organization Name:DAWKINS FAMILY DENTAL CLINIC PA
Other - Org Name:W EDWIN DAWKINS JR DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WARD
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:DAWKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:662-234-5725
Mailing Address - Street 1:440 NORTH LAMAR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655
Mailing Address - Country:US
Mailing Address - Phone:662-234-5725
Mailing Address - Fax:662-234-4811
Practice Address - Street 1:440 NORTH LAMAR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655
Practice Address - Country:US
Practice Address - Phone:662-234-5725
Practice Address - Fax:662-234-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2668122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
467588OtherUNITED CONCORDIA