Healthcare Provider Details

I. General information

NPI: 1366576704
Provider Name (Legal Business Name): LAVONNE MARIE SAWYER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 6TH AVE STE 104
TACOMA WA
98406
US

IV. Provider business mailing address

828 S FAIRMONT AVE
LODI CA
95240-5117
US

V. Phone/Fax

Practice location:
  • Phone: 253-777-4461
  • Fax: 253-752-0220
Mailing address:
  • Phone: 209-333-8484
  • Fax: 209-333-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00008096
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32587
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8096
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: