Provider Demographics
NPI:1841648466
Name:DAWSON, ANDRINA MICHELL (RDH)
Entity type:Individual
Prefix:MRS
First Name:ANDRINA
Middle Name:MICHELL
Last Name:DAWSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:ANDRINA
Other - Middle Name:MICHELLE
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:7101 HOFF ST
Mailing Address - Street 2:BLDG 9240
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905-5645
Mailing Address - Country:US
Mailing Address - Phone:706-544-3103
Mailing Address - Fax:706-544-1933
Practice Address - Street 1:7101 HOFF ST
Practice Address - Street 2:BLDG 9240
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-5645
Practice Address - Country:US
Practice Address - Phone:706-544-3103
Practice Address - Fax:706-544-1933
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011980124Q00000X
FL19428124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist