Provider Demographics
NPI:1285760686
Name:LAWSON, WARREN AMEDEO (DDS, MSD)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:AMEDEO
Last Name:LAWSON
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W NIFONG BLVD STE 4B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6804
Mailing Address - Country:US
Mailing Address - Phone:573-445-3266
Mailing Address - Fax:573-256-4429
Practice Address - Street 1:601 W NIFONG BLVD STE 4B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6804
Practice Address - Country:US
Practice Address - Phone:576-256-2121
Practice Address - Fax:573-256-4429
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001549851223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics