Provider Demographics
NPI:1780933374
Name:SAWYER, ROBERT EDWIN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWIN
Last Name:SAWYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 RANCH RD 1431
Mailing Address - Street 2:BOX 1606
Mailing Address - City:KINGSLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78639
Mailing Address - Country:US
Mailing Address - Phone:325-388-6021
Mailing Address - Fax:325-388-9991
Practice Address - Street 1:1117 RANCH RD 1431
Practice Address - Street 2:POB 1606
Practice Address - City:KINGSLAND
Practice Address - State:TX
Practice Address - Zip Code:78639-4055
Practice Address - Country:US
Practice Address - Phone:325-388-6021
Practice Address - Fax:325-388-9991
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX283321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1235553900OtherCENTRAL TEXAS FAMILY DENTISTRY PC