MEDICARE: DR. CHAD VERNON DAWSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D-3633	ID
2	1223E0200X	Endodontics	D-3633	ID
3	1223E0200X	Endodontics	DE60445830	WA
4	1223E0200X	Endodontics	DEN.00010388	CO

General Provider Information

NPI Number	:	1679551626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD VERNON DAWSON DDS

Provider Business Mailing Address
First Line	:	7409 W GRANDRIDGE BLVD
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-6710
Country	:	US
Telephone Number	:	509-783-1335
Fax Number	:	509-783-1524

Provider Business Practice Location Address
First Line	:	7409 W GRANDRIDGE BLVD
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-6710
Country	:	US
Telephone Number	:	509-783-1335
Fax Number	:	509-783-1524

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	05/22/2014

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