1033200555 NPI number — CHRISTINE LENTZ DDS AND LISA EGBERT DDS PS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033200555 NPI number — CHRISTINE LENTZ DDS AND LISA EGBERT DDS PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTINE LENTZ DDS AND LISA EGBERT DDS PS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CREEKSIDE DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033200555
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19214 BOTHELL WAY NE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
BOTHELL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-485-0300
Provider Business Mailing Address Fax Number:
425-402-9186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19214 BOTHELL WAY NE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BOTHELL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-485-0300
Provider Business Practice Location Address Fax Number:
425-402-9186
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EGBERT
Authorized Official First Name:
LISA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
VP AND TREAS
Authorized Official Telephone Number:
425-485-0300

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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