Provider Demographics
NPI:1245309855
Name:CIRTAUT, LINDA MAE (DDS, PS)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MAE
Last Name:CIRTAUT
Suffix:
Gender:F
Credentials:DDS, PS
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 13828
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98082-1828
Mailing Address - Country:US
Mailing Address - Phone:425-745-2703
Mailing Address - Fax:
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:98012-4051
Practice Address - Country:US
Practice Address - Phone:425-745-2703
Practice Address - Fax:425-316-0485
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA52331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice