Provider Demographics
NPI:1730159096
Name:DAWSON, JAMIAH K (DENTIST)
Entity type:Individual
Prefix:DR
First Name:JAMIAH
Middle Name:K
Last Name:DAWSON
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-9410
Mailing Address - Country:US
Mailing Address - Phone:757-873-3407
Mailing Address - Fax:
Practice Address - Street 1:11828 FISHING POINT DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4500
Practice Address - Country:US
Practice Address - Phone:757-873-3407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411148122300000X
GADN012564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN