Provider Demographics
NPI:1366576704
Name:SAWYER, LAVONNE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:LAVONNE
Middle Name:MARIE
Last Name:SAWYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 S FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5117
Mailing Address - Country:US
Mailing Address - Phone:209-333-8484
Mailing Address - Fax:209-333-1428
Practice Address - Street 1:3602 6TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406
Practice Address - Country:US
Practice Address - Phone:253-777-4461
Practice Address - Fax:253-752-0220
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA325871223G0001X
WA80961223G0001X
WADE00008096122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93187Medicare ID - Type UnspecifiedPROVIDER NUMBER