Provider Demographics
NPI:1831619204
Name:DEACON, ATTICUS LAWTON (DMD)
Entity type:Individual
Prefix:DR
First Name:ATTICUS
Middle Name:LAWTON
Last Name:DEACON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 CREIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-4681
Mailing Address - Country:US
Mailing Address - Phone:251-458-2616
Mailing Address - Fax:
Practice Address - Street 1:1133 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8607
Practice Address - Country:US
Practice Address - Phone:850-462-5035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist