Provider Demographics
NPI:1285001065
Name:SARAH LUETKE, PLLC
Entity Type:Organization
Organization Name:SARAH LUETKE, PLLC
Other - Org Name:SOUND DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUETKE
Authorized Official - Suffix:
Authorized Official - Credentials:LD, RDH
Authorized Official - Phone:206-319-3766
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98345-0046
Mailing Address - Country:US
Mailing Address - Phone:206-319-3766
Mailing Address - Fax:206-745-3811
Practice Address - Street 1:2235 NE CASTLE DR
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8068
Practice Address - Country:US
Practice Address - Phone:206-319-3766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X, 122400000X, 124Q00000X
WAHL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No122400000XDental ProvidersDenturistGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty