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NPI Code Detail

MEDICARE: ELLEN MCKENZIE SAWYER DMD

MEDICARE:   ELLEN MCKENZIE SAWYER  DMD
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
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice Dentistry1002651WI

General Provider Information

NPI Number : 1619548773
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN MCKENZIE SAWYER DMD
Provider Business Mailing Address
First Line : 5130 UNITY WAY
Second Line :
City : MADISON
State : WI
Zip : 53718-6993
Country : US
Telephone Number : 423-326-7797
Fax Number :
Provider Business Practice Location Address
First Line : 140 N CITY STATION DR
Second Line :
City : SUN PRAIRIE
State : WI
Zip : 53590-4642
Country : US
Telephone Number : 608-837-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2021
Last Update Date : 07/20/2021

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Directions to “ ELLEN MCKENZIE SAWYER DMD” Practice Location

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