Healthcare Provider Details

I. General information

NPI: 1952052045
Provider Name (Legal Business Name): SAGAWA DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 5TH AVE SE STE 101
OLYMPIA WA
98501-1505
US

IV. Provider business mailing address

911 5TH AVE SE STE 101
OLYMPIA WA
98501-1505
US

V. Phone/Fax

Practice location:
  • Phone: 360-352-9391
  • Fax:
Mailing address:
  • Phone: 360-352-9391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEZLY HARTLEY
Title or Position: FINANCIAL COORDINATOR/BOOKKEEPER
Credential:
Phone: 360-352-9391