Provider Demographics
NPI:1720628985
Name:T LYONS & J RAWLINS DDS INC
Entity Type:Organization
Organization Name:T LYONS & J RAWLINS DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SASO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-479-3432
Mailing Address - Street 1:5010 LAGUNA BLVD # 100
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4197
Mailing Address - Country:US
Mailing Address - Phone:916-442-7873
Mailing Address - Fax:
Practice Address - Street 1:7806 MADISON AVE STE 200
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3593
Practice Address - Country:US
Practice Address - Phone:916-442-7873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty