William Clark Lubken, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

4640 Issued in WA

Practice address

5122 Olympic Dr NW
Gig Harbor, WA 98335-1767

Phone

(253) 851-6667

NPI assigned

May 1, 2006

Last updated

Sep 26, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Previously, effective Aug 11, 2016 through Aug 11, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222387200000",
    "number": "1154389229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5122 OLYMPIC DR NW",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351768",
            "telephone_number": "253-851-6667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5122 OLYMPIC DR NW",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351767",
            "telephone_number": "253-851-6667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUBKEN",
        "first_name": "WILLIAM",
        "middle_name": "CLARK",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2008-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WA",
            "license": "4640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Gig Harbor, WA
• Providers in Gig Harbor, WA by specialty
• Periodontics in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.