Provider Demographics
NPI:1952052045
Name:SAGAWA DDS PLLC
Entity Type:Organization
Organization Name:SAGAWA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR/BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:LEZLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-352-9391
Mailing Address - Street 1:911 5TH AVE SE STE 101
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1505
Mailing Address - Country:US
Mailing Address - Phone:360-352-9391
Mailing Address - Fax:
Practice Address - Street 1:911 5TH AVE SE STE 101
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1505
Practice Address - Country:US
Practice Address - Phone:360-352-9391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA10899OtherSTATE LICENSE