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General NPI Number Information
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NPI Number | 1518571538
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Entity Type | Organization
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Legal Business Name | THAYNE DAWSON DMD LLC
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Dates
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Enumeration Date | 09/08/2020
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 3719 E MERIDIAN LOOP STE B
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City | WASILLA
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State | AK
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Zip | 99654-7273
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Country | US
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Telephone | 907-373-2440
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Fax | 907-373-1920
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Provider Business Mailing Address
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Address Line | 6110 N TALGACH VIEW DR
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City | WASILLA
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State | AK
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Zip | 99654-9044
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Country | US
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Telephone | 208-351-6538
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Fax | 907-373-1920
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Authorized Official
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Title or Position | OWNER
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Name | DR. THAYNE JORAY DAWSON
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Credential | DMD
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Telephone | 907-707-9421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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