Healthcare Provider Details

I. General information

NPI: 1033345111
Provider Name (Legal Business Name): DOUGLAS A. DAWS, D.D.S.,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 N BRAND BLVD
GLENDALE CA
91202-2906
US

IV. Provider business mailing address

3390 LOMA VISTA RD SUITE B
VENTURA CA
93003-3078
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-8955
  • Fax:
Mailing address:
  • Phone: 818-242-8955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number32289
License Number StateCA

VIII. Authorized Official

Name: DR. DOUGLAS A. DAWS
Title or Position: OWNER
Credential: DDS
Phone: 818-242-8955