Healthcare Provider Details

I. General information

NPI: 1801872114
Provider Name (Legal Business Name): SARAH LAWSON D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOONE RD
BREMERTON WA
98312-1894
US

IV. Provider business mailing address

PSC 557 BOX 1153
FPO AP
96379
US

V. Phone/Fax

Practice location:
  • Phone: 301-272-7262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00010450
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10450
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: