Healthcare Provider Details

I. General information

NPI: 1619197134
Provider Name (Legal Business Name): MICHAEL K. DAWSON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 PENNS VALLEY RD STE 2
SPRING MILLS PA
16875-8500
US

IV. Provider business mailing address

4570 PENNS VALLEY RD STE 2
SPRING MILLS PA
16875-8500
US

V. Phone/Fax

Practice location:
  • Phone: 814-422-8768
  • Fax: 814-422-0379
Mailing address:
  • Phone: 814-422-8768
  • Fax: 814-422-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS030830L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: