Healthcare Provider Details

I. General information

NPI: 1265813521
Provider Name (Legal Business Name): LAWSON DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 04/03/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 NORTHWEST 128TH STREET
URBANDALE IA
50323-1728
US

IV. Provider business mailing address

4444 NORTHWEST 128TH STREET
URBANDALE IA
50323-1728
US

V. Phone/Fax

Practice location:
  • Phone: 515-278-4366
  • Fax: 515-278-4624
Mailing address:
  • Phone: 515-278-4366
  • Fax: 515-278-4624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number08512
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JESSICA LAWSON
Title or Position: OWNER
Credential: DDS
Phone: 515-278-4366