NPIMap

Organization Active NPI

Lake Sammamish Family Dentistry

  • General Practice Dentistry
  • Issaquah, WA
National Provider Identifier
1093036709
Registry record updated Jun 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
60065361 Issued in WA
Legal business name
LAKE SAMMAMISH FAMILY DENTISTRY
Practice address
5712 E Lake Sammamish Pkwy SE
Ste 108
Issaquah, WA 98029-8943
Phone
(425) 392-3900
NPI assigned
Jun 16, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Anna Lisin, DDSNPI 1447334222
Title
Dentist
Phone
(425) 392-3900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 60065361 WA Primary

Addresses

Primary practice location

5712 E Lake Sammamish Pkwy SE
Ste 108
Issaquah, WA 98029-8943

Mailing address

5712 E Lake Sammamish Pkwy SE
Ste 108
Issaquah, WA 98029-8943
Phone (425) 392-3900

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276646400000",
    "number": "1093036709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5712 E LAKE SAMMAMISH PKWY SE",
            "address_2": "STE 108",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980298943",
            "telephone_number": "425-392-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5712 E LAKE SAMMAMISH PKWY SE",
            "address_2": "STE 108",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980298943",
            "telephone_number": "425-392-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SAMMAMISH FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-16",
        "last_updated": "2010-06-16",
        "status": "A",
        "authorized_official_last_name": "LISIN",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "425-392-3900",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "60065361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.