Provider Demographics
NPI:1063905446
Name:DAWSON, ALYSSA CEJA (DDS)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:CEJA
Last Name:DAWSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 RIALTO BLVD APT 16010
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-0055
Mailing Address - Country:US
Mailing Address - Phone:817-808-9953
Mailing Address - Fax:
Practice Address - Street 1:165 HARGRAVES DR STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-4795
Practice Address - Country:US
Practice Address - Phone:512-758-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice