Basic Information
| Provider Information | |||||||||
| NPI: | 1841648466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAWSON | ||||||||
| FirstName: | ANDRINA | ||||||||
| MiddleName: | MICHELL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.DH. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHANNON | ||||||||
| OtherFirstName: | ANDRINA | ||||||||
| OtherMiddleName: | MICHELLE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | R.D.H. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7101 HOFF ST | ||||||||
| Address2: | BLDG 9240 | ||||||||
| City: | FORT BENNING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319055645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065443103 | ||||||||
| FaxNumber: | 7065441933 | ||||||||
| Practice Location | |||||||||
| Address1: | 7101 HOFF ST | ||||||||
| Address2: | BLDG 9240 | ||||||||
| City: | FORT BENNING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319055645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065443103 | ||||||||
| FaxNumber: | 7065441933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2016 | ||||||||
| LastUpdateDate: | 05/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 011980 | GA | Y | Dental Providers | Dental Hygienist | 124Q00000X | 19428 | FL | N | Dental Providers | Dental Hygienist |
No ID Information.