Provider Demographics
NPI:1962927335
Name:DAWSON, FREDERICK M (DMD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:M
Last Name:DAWSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FT BRAGG DENTAC ATTN: JOEL DENTAL CLINIC BLDG M-4861
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-906-9060
Mailing Address - Fax:
Practice Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:NC
Practice Address - Zip Code:09180-3100
Practice Address - Country:US
Practice Address - Phone:314-590-7163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO41437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist