Provider Demographics
NPI:1427731710
Name:LAWSON, KEELY S (IPDH)
Entity type:Individual
Prefix:
First Name:KEELY
Middle Name:S
Last Name:LAWSON
Suffix:
Gender:F
Credentials:IPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 ESSEX ST LOT 87
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2643
Mailing Address - Country:US
Mailing Address - Phone:207-991-8893
Mailing Address - Fax:
Practice Address - Street 1:979 ESSEX ST LOT 87
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2643
Practice Address - Country:US
Practice Address - Phone:207-991-8893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH4306124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist