Provider Demographics
NPI:1902017734
Name:JOHN ALLEN FAWSON
Entity Type:Organization
Organization Name:JOHN ALLEN FAWSON
Other - Org Name:HOME CARE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-781-4400
Mailing Address - Street 1:618 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-2317
Mailing Address - Country:US
Mailing Address - Phone:559-781-4400
Mailing Address - Fax:559-781-4411
Practice Address - Street 1:618 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-2317
Practice Address - Country:US
Practice Address - Phone:559-781-4400
Practice Address - Fax:559-781-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA234991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty