MEDICARE: TERRY WAYNE DAWSON DOS

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	1223D0001X	Public Health Dentistry	5282	NC

General Provider Information

NPI Number	:	1861496887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY WAYNE DAWSON DOS

Provider Business Mailing Address
First Line	:	1817 EASTCHESTER DR
Second Line	:	STE 101
City	:	HIGH POINT
State	:	NC
Zip	:	27265-1488
Country	:	US
Telephone Number	:	336-889-9916
Fax Number	:	336-889-9159

Provider Business Practice Location Address
First Line	:	1817 EASTCHESTER DR
Second Line	:	STE 101
City	:	HIGH POINT
State	:	NC
Zip	:	27265-1488
Country	:	US
Telephone Number	:	336-889-9916
Fax Number	:	336-889-9159

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/08/2007

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