Healthcare Provider Details

I. General information

NPI: 1568193597
Provider Name (Legal Business Name): ALICE CAWSON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICE FORREST RDH

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N WASHINGTON SQ OFC 378
LANSING MI
48933-1617
US

IV. Provider business mailing address

100 CROSSING BLVD STE 300
FRAMINGHAM MA
01702-5555
US

V. Phone/Fax

Practice location:
  • Phone: 888-964-6681
  • Fax: 888-662-0859
Mailing address:
  • Phone: 617-964-6681
  • Fax: 339-686-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902013761
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: