Provider Demographics
NPI:1386777944
Name:DAWSON, JOHN DAVID (OPA C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:DAWSON
Suffix:
Gender:M
Credentials:OPA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0500
Mailing Address - Country:US
Mailing Address - Phone:214-369-8555
Mailing Address - Fax:214-369-2683
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE C-106
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:214-823-7090
Practice Address - Fax:214-823-1644
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0812246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0851OtherOPA CERTIFICATION