Individual
TERDELL MYCHAL DAWES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
PIGEON SPRINGS NHA HOUSING 062, FORT DEFIANCE, AZ 86504
(928) 729-2130
(928) 729-5475
Mailing address
PO BOX 74, SAINT MICHAELS, AZ 86511-0074
(928) 729-2130
(928) 729-5475
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
03/06/2013
Last updated
03/06/2013
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