Provider Demographics
NPI:1548213788
Name:KINTNER, PATRICK TRACY (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:TRACY
Last Name:KINTNER
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 1:3216 NE 45 PLACE STE #211
Mailing Address - Street 2:LAKEVIEW MEDICAL BLDG
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:206-527-7001
Mailing Address - Fax:
Practice Address - Street 1:3216 NE 45 PLACE STE #211
Practice Address - Street 2:LAKEVIEW MEDICAL BLDG
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-527-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA05846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5068606Medicaid