Active NPI
Thayne Joray Dawson, DMD
- General Practice Dentistry
- Wasilla, AK
National Provider Identifier
1831628148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 140965
- Practice address
- 3719 E Meridian Loop Ste B
Wasilla, AK 99654-7273 - Phone
- (907) 373-2440
- Fax
- (907) 373-1920
- NPI assigned
- Jun 8, 2017
- Reactivated
- Jul 17, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 140965 | AK | Primary |
| Dentist | 122300000X | DEN-DEN-LIC-13443 | MT |
Addresses
Primary practice location
3719 E Meridian Loop Ste B
Wasilla, AK 99654-7273
Mailing address
3719 E Meridian Loop Ste B
Wasilla, AK 99654-7273
Phone (907) 373-2440
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 140965 | AK | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Donald R McLean | Current | Accepting new patients | |
| Thayne Dawson DMD LLC | Current | Accepting new patients |
Locations
3719 E Meridian Loop
Ste B
Wasilla, AK 99654
Phone (907) 373-2440
Interoperability endpoints
- https://api.platform.athenahealth.com/17085/brand/1/csg/1/fhir/r4
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dental Clinic/Center
- Wasilla, AK
- NPI 1982238622
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690761600000",
"number": "1831628148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3719 E MERIDIAN LOOP STE B",
"city": "WASILLA",
"state": "AK",
"postal_code": "996547273",
"telephone_number": "907-373-2440",
"fax_number": "907-373-1920"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3719 E MERIDIAN LOOP STE B",
"city": "WASILLA",
"state": "AK",
"postal_code": "996547273",
"telephone_number": "907-373-2440",
"fax_number": "907-373-1920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAWSON",
"first_name": "THAYNE",
"middle_name": "JORAY",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-08",
"last_updated": "2023-07-31",
"certification_date": "2023-07-31",
"deactivation_date": "2023-06-14",
"reactivation_date": "2023-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AK",
"license": "140965",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MT",
"license": "DEN-DEN-LIC-13443",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.