Provider Demographics
NPI:1093945131
Name:LINSENMAYER DENTISTRY, LLC
Entity Type:Organization
Organization Name:LINSENMAYER DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:LINSENMAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MPH MSD
Authorized Official - Phone:206-920-1046
Mailing Address - Street 1:510 WARD ST # 201
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3981
Mailing Address - Country:US
Mailing Address - Phone:206-920-1046
Mailing Address - Fax:
Practice Address - Street 1:21 JEFFERSON WAY STE 102
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5951
Practice Address - Country:US
Practice Address - Phone:907-220-9231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7075122300000X
AK1287122300000X
AK1681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5017983Medicaid
1639352560OtherNPI INDIVIDUAL
AKDDGO25Medicaid