1073643771 NPI number — INGRID LAWATY D.M.D.

Table of content: INGRID LAWATY D.M.D. (NPI 1073643771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073643771 NPI number — INGRID LAWATY D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWATY
Provider First Name:
INGRID
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HLAWATY
Provider Other First Name:
INGRID
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073643771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 EAST ARRELLAGA STREET
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93103-4236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-965-9107
Provider Business Mailing Address Fax Number:
805-965-9108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 EAST ARRELLAGA STREET
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93103-4236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-965-9107
Provider Business Practice Location Address Fax Number:
805-965-9108
Provider Enumeration Date:
03/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  41733 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 77-0545644 . This is a "TAX I D" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".