Provider Demographics
NPI:1568940120
Name:DIONISIO, LADY ANN SUGAY (DMD)
Entity type:Individual
Prefix:DR
First Name:LADY ANN
Middle Name:SUGAY
Last Name:DIONISIO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17018 28TH ST E
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6772
Mailing Address - Country:US
Mailing Address - Phone:925-678-0475
Mailing Address - Fax:
Practice Address - Street 1:5401 6TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2618
Practice Address - Country:US
Practice Address - Phone:253-759-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-04
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61578180122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist