MEDICARE: DR. KEVIN BREWSTER SAWYER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	31528	CA

General Provider Information

NPI Number	:	1023265071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN BREWSTER SAWYER DDS

Provider Business Mailing Address
First Line	:	646 LOS ALTOS RANCHO
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-4942
Country	:	US
Telephone Number	:	650-948-5355
Fax Number	:	650-948-5826

Provider Business Practice Location Address
First Line	:	646 LOS ALTOS RANCHO
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-4942
Country	:	US
Telephone Number	:	650-948-5355
Fax Number	:	650-948-5826

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	08/21/2008

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