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General NPI Number Information
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NPI Number | 1720628985
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Entity Type | Organization
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Legal Business Name | T LYONS & J RAWLINS DDS INC
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Dates
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Enumeration Date | 01/15/2020
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 7806 MADISON AVE STE 200
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City | FAIR OAKS
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State | CA
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Zip | 95628-3593
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Country | US
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Telephone | 916-442-7873
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Fax |
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Provider Business Mailing Address
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Address Line | 5010 LAGUNA BLVD # 100
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City | ELK GROVE
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State | CA
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Zip | 95758-4197
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Country | US
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Telephone | 916-442-7873
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | JEN SASO
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Credential |
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Telephone | 916-479-3432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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