MEDICARE: DR. RANDALL EVERT LAWSON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019-019857	IL

General Provider Information

NPI Number	:	1730151176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL EVERT LAWSON D.D.S.

Provider Business Mailing Address
First Line	:	505 W COLLEGE AVE
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-2405
Country	:	US
Telephone Number	:	217-245-5319
Fax Number	:	217-291-0219

Provider Business Practice Location Address
First Line	:	505 W COLLEGE AVE
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-2405
Country	:	US
Telephone Number	:	217-245-5319
Fax Number	:	217-291-0219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	01/31/2018

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