Provider Demographics
NPI:1992991152
Name:DAWSON, DAYTON W (DDS)
Entity type:Individual
Prefix:DR
First Name:DAYTON
Middle Name:W
Last Name:DAWSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-9468
Mailing Address - Country:US
Mailing Address - Phone:317-745-5173
Mailing Address - Fax:317-745-5023
Practice Address - Street 1:1669 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-9468
Practice Address - Country:US
Practice Address - Phone:317-745-5173
Practice Address - Fax:317-745-5023
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011067A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100133020Medicaid