Healthcare Provider Details

I. General information

NPI: 1073643771
Provider Name (Legal Business Name): INGRID LAWATY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: INGRID HLAWATY D.M.D.

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 EAST ARRELLAGA STREET SUITE 203
SANTA BARBARA CA
93103-4236
US

IV. Provider business mailing address

601 EAST ARRELLAGA STREET SUITE 203
SANTA BARBARA CA
93103-4236
US

V. Phone/Fax

Practice location:
  • Phone: 805-965-9107
  • Fax: 805-965-9108
Mailing address:
  • Phone: 805-965-9107
  • Fax: 805-965-9108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number41733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: