Healthcare Provider Details

I. General information

NPI: 1003073511
Provider Name (Legal Business Name): BRAD J DAWSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1597 WOODLAND PARK DR STE 200
LAYTON UT
84041
US

IV. Provider business mailing address

702 BARNHILL DR SUITE 4205
INDIANAPOLIS IN
46202-5128
US

V. Phone/Fax

Practice location:
  • Phone: 801-544-1940
  • Fax: 801-896-0645
Mailing address:
  • Phone: 317-278-4238
  • Fax: 317-278-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3493889922
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3493889922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: