Provider Demographics
NPI:1215454442
Name:LAWSON, AUDREY (DMD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:LAWSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 S LAMAR BLVD APT 702
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2187
Mailing Address - Country:US
Mailing Address - Phone:859-512-7357
Mailing Address - Fax:
Practice Address - Street 1:3310 W BRAKER LN BLDG 1-100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-0002
Practice Address - Country:US
Practice Address - Phone:512-617-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice