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General NPI Number Information
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NPI Number | 1902017734
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Entity Type | Organization
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Legal Business Name | JOHN ALLEN FAWSON
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 618 N MAIN ST
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City | PORTERVILLE
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State | CA
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Zip | 93257-2317
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Country | US
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Telephone | 559-781-4400
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Fax | 559-781-4411
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Provider Business Mailing Address
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Address Line | 618 N MAIN ST
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City | PORTERVILLE
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State | CA
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Zip | 93257-2317
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Country | US
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Telephone | 559-781-4400
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Fax | 559-781-4411
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Authorized Official
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Title or Position | OWENER
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Name | DR. JOHN ALLEN FAWSON
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Credential | D.D.S
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Telephone | 559-781-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 23499
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License Number State | CA
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