Provider Demographics
NPI:1164860839
Name:SHANNON SAWYER DMD, INC.
Entity Type:Organization
Organization Name:SHANNON SAWYER DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:804-687-8405
Mailing Address - Street 1:7802 TIMBERLAKE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2602
Mailing Address - Country:US
Mailing Address - Phone:434-239-6948
Mailing Address - Fax:434-239-9158
Practice Address - Street 1:7802 TIMBERLAKE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2602
Practice Address - Country:US
Practice Address - Phone:434-239-6948
Practice Address - Fax:434-239-9158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014125291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty