Healthcare Provider Details

I. General information

NPI: 1801212048
Provider Name (Legal Business Name): JONATHAN HUNTER DAWSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8840 BLAKENEY PROFESSIONAL DR
CHARLOTTE NC
28277-6718
US

IV. Provider business mailing address

3130 SORA AVE
LOUISVILLE KY
40213-1243
US

V. Phone/Fax

Practice location:
  • Phone: 704-716-9840
  • Fax:
Mailing address:
  • Phone: 336-516-6693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number10593
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: