Basic Information
Provider Information | |||||||||
NPI: | 1639352560 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LINSENMAYER | ||||||||
FirstName: | KRISTI | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DDS MPH MSD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LINSENMAYER | ||||||||
OtherFirstName: | KRISTI | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DDS MPH MSD | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 3364 | ||||||||
Address2: |   | ||||||||
City: | SEATTLE | ||||||||
State: | WA | ||||||||
PostalCode: | 981143364 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2063249360 | ||||||||
FaxNumber: | 2063248910 | ||||||||
Practice Location | |||||||||
Address1: | 611 12TH AVE S | ||||||||
Address2: | SUITE 200 | ||||||||
City: | SEATTLE | ||||||||
State: | WA | ||||||||
PostalCode: | 981441910 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2063249360 | ||||||||
FaxNumber: | 2063248910 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/13/2007 | ||||||||
LastUpdateDate: | 02/19/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DE00007075 | WA | Y |   | Dental Providers | Dentist |   |
ID Information
ID | Type | State | Issuer | Description | DE00007075 | 01 | WA | LICENSE NUMBER | OTHER | FL0319182 | 01 | WA | DEA | OTHER | 5017983 | 05 | WA |   | MEDICAID |