Provider Demographics
NPI:1285861260
Name:SAWYER, SHANNON (DMD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SAWYER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0386201223P0221X
VA04014125291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008214166Medicaid
VA15487OtherDORAL