Provider Demographics
NPI:1427540111
Name:URRUTIA, DAWSON
Entity type:Individual
Prefix:
First Name:DAWSON
Middle Name:
Last Name:URRUTIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HIGHWAY 71 N STE 112
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-5046
Mailing Address - Country:US
Mailing Address - Phone:479-370-4966
Mailing Address - Fax:479-339-8767
Practice Address - Street 1:108 HIGHWAY 71 N STE 112
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-5046
Practice Address - Country:US
Practice Address - Phone:479-370-4966
Practice Address - Fax:479-339-8767
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4271122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist