Provider Demographics
NPI:1164671673
Name:LINGENBRINK, JEFFREY CLARK (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CLARK
Last Name:LINGENBRINK
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2257
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-0960
Mailing Address - Country:US
Mailing Address - Phone:360-697-3008
Mailing Address - Fax:360-697-1566
Practice Address - Street 1:18825 CALDART AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8714
Practice Address - Country:US
Practice Address - Phone:360-697-3008
Practice Address - Fax:360-697-1566
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000104541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics