Provider Demographics
NPI:1548807472
Name:DUDLEY, DAWN (RDH, LPN)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:RDH, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DUQUESNE
Mailing Address - State:PA
Mailing Address - Zip Code:15110-1115
Mailing Address - Country:US
Mailing Address - Phone:412-414-7671
Mailing Address - Fax:
Practice Address - Street 1:424 S 1ST ST
Practice Address - Street 2:
Practice Address - City:DUQUESNE
Practice Address - State:PA
Practice Address - Zip Code:15110-1115
Practice Address - Country:US
Practice Address - Phone:412-414-7671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN304528164W00000X
PADH010420L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No164W00000XNursing Service ProvidersLicensed Practical Nurse