Provider Demographics
NPI:1073688404
Name:LINSSEN, PIETER (DDS)
Entity Type:Individual
Prefix:
First Name:PIETER
Middle Name:
Last Name:LINSSEN
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 1:8769 AUBURN FOLSOM RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6203
Mailing Address - Country:US
Mailing Address - Phone:916-791-4719
Mailing Address - Fax:916-791-3091
Practice Address - Street 1:8769 AUBURN FOLSOM RD
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6203
Practice Address - Country:US
Practice Address - Phone:916-791-4719
Practice Address - Fax:916-791-3091
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice