Provider Demographics
NPI:1396084133
Name:LAWSON, RENEE ALENE (RDH)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ALENE
Last Name:LAWSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 GLOXINA ST
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3321
Mailing Address - Country:US
Mailing Address - Phone:760-696-6243
Mailing Address - Fax:
Practice Address - Street 1:4910 DIRECTORS PL
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3811
Practice Address - Country:US
Practice Address - Phone:858-768-2956
Practice Address - Fax:858-768-0510
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8689124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist