Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 3493889922 | UT |
N | 1223X0400X | Orthodontists | 3493889922 | UT |
NPI | 1003073511 |
---|---|
Provider Name | Dr. Brad J Dawson |
First Address | Indianapolis, IN 46202-5128 |
Second Address | Layton, UT 84041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 15/05/2018 |