1134691058 NPI number — DAWSON DERMATOLOGY GROUP PLLC

Table of content: (NPI 1134691058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134691058 NPI number — DAWSON DERMATOLOGY GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAWSON DERMATOLOGY GROUP PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134691058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
499 E HAMPDEN AVE STE 390
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80113-2780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-390-0795
Provider Business Mailing Address Fax Number:
720-386-3395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
499 E HAMPDEN AVE STE 390
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80113-2780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-390-0795
Provider Business Practice Location Address Fax Number:
720-386-3395
Provider Enumeration Date:
12/18/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAWSON
Authorized Official First Name:
ANNELISE
Authorized Official Middle Name:
LORELEI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-390-0795

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)