Provider Demographics
NPI:1669421582
Name:LAWSON, DANIELA JEANETTE (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:JEANETTE
Last Name:LAWSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:15887 CUMBERLAND RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4329
Mailing Address - Country:US
Mailing Address - Phone:317-770-4783
Mailing Address - Fax:317-770-4785
Practice Address - Street 1:15887 CUMBERLAND RD
Practice Address - Street 2:SUITE 104
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4329
Practice Address - Country:US
Practice Address - Phone:317-770-4783
Practice Address - Fax:317-770-4785
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007812A332BC3200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1669421582Medicaid