Provider Demographics
NPI:1073643771
Name:LAWATY, INGRID (DMD)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:LAWATY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:
Other - Last Name:HLAWATY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:601 EAST ARRELLAGA STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-4236
Mailing Address - Country:US
Mailing Address - Phone:805-965-9107
Mailing Address - Fax:805-965-9108
Practice Address - Street 1:601 EAST ARRELLAGA STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-4236
Practice Address - Country:US
Practice Address - Phone:805-965-9107
Practice Address - Fax:805-965-9108
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77-0545644OtherTAX I D