Provider Demographics
NPI:1477724409
Name:LINGLE, PHILIP J (DDS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:LINGLE
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 1:510 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-1604
Mailing Address - Country:US
Mailing Address - Phone:763-389-1373
Mailing Address - Fax:763-389-0538
Practice Address - Street 1:510 1ST ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1604
Practice Address - Country:US
Practice Address - Phone:763-389-1373
Practice Address - Fax:763-389-0538
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN90191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice