Provider Demographics
NPI:1457464802
Name:LINDA M CIRTAUT DDS PS
Entity Type:Organization
Organization Name:LINDA M CIRTAUT DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CIRTAUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PS
Authorized Official - Phone:425-745-2703
Mailing Address - Street 1:PO BOX 13828
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98082
Mailing Address - Country:US
Mailing Address - Phone:425-745-2703
Mailing Address - Fax:425-316-0485
Practice Address - Street 1:1025 153RD ST SE
Practice Address - Street 2:SUITE 103
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:425-745-2703
Practice Address - Fax:425-316-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00005233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty