Provider Demographics
NPI:1942684899
Name:RICHARD M. DAWDY, DDS PLLC
Entity Type:Organization
Organization Name:RICHARD M. DAWDY, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DAWDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-393-1131
Mailing Address - Street 1:1100 E MILLER RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-5311
Mailing Address - Country:US
Mailing Address - Phone:517-393-1131
Mailing Address - Fax:517-393-0404
Practice Address - Street 1:1100 E MILLER RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-5311
Practice Address - Country:US
Practice Address - Phone:517-393-1131
Practice Address - Fax:517-393-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011487122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty