Healthcare Provider Details

I. General information

NPI: 1427672690
Provider Name (Legal Business Name): RICHARD CHARLES DAWSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20118 N 67TH AVE STE 308
GLENDALE AZ
85308-4621
US

IV. Provider business mailing address

4744 E MICHIGAN AVE
PHOENIX AZ
85032-9516
US

V. Phone/Fax

Practice location:
  • Phone: 480-530-3663
  • Fax: 480-530-3536
Mailing address:
  • Phone: 385-228-9747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD010670
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: