Healthcare Provider Details

I. General information

NPI: 1295749307
Provider Name (Legal Business Name): DOUGLAS A DAWS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/31/2014
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

1023 N BRAND BLVD
GLENDALE CA
91202-2906
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-8955
  • Fax: 818-242-8995
Mailing address:
  • Phone: 818-242-8955
  • Fax: 818-242-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: