Provider Demographics
NPI:1295750206
Name:SAWYER, KELLY KOLI (DDS)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:KOLI
Last Name:SAWYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3013 GREEN MEADOW
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6435
Mailing Address - Country:US
Mailing Address - Phone:325-947-7777
Mailing Address - Fax:325-947-7771
Practice Address - Street 1:3013 GREEN MEADOW
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6435
Practice Address - Country:US
Practice Address - Phone:325-947-7777
Practice Address - Fax:325-947-7771
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry