Provider Demographics
NPI:1508931148
Name:SACKMAN, TRIENEL M (DDS)
Entity Type:Individual
Prefix:
First Name:TRIENEL
Middle Name:M
Last Name:SACKMAN
Suffix:
Gender:F
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:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-0112
Mailing Address - Fax:206-764-0489
Practice Address - Street 1:31775 STATE ROUTE 20
Practice Address - Street 2:SUITE A-3
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5139
Practice Address - Country:US
Practice Address - Phone:360-679-9216
Practice Address - Fax:360-679-9239
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000080611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5028568Medicaid
WA0174962OtherDEPT LABOR & INDUSTRIES
WA8324SAOtherREGENCE BLUE SHIELD