Lance F Wicklund, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

WA9320 Issued in WA

Practice address

9723 Coppertop Loop NE
Suite 101
Bainbridge Island, WA 98110

Phone

(206) 842-6624

Fax

(206) 780-5654

NPI assigned

Nov 30, 2006

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

Enrolled in WA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wicklund Dental,

  • Dentist
  • Bainbridge Island, WA
  • NPI 1194270702
  NPD (past) Authorized official

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484870400000",
    "number": "1831267947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9723 COPPERTOP LOOP NE",
            "address_2": "SUITE 101",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981103699",
            "telephone_number": "206-842-6624",
            "fax_number": "206-780-5654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9723 COPPERTOP LOOP NE",
            "address_2": "SUITE 101",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "98110",
            "telephone_number": "206-842-6624",
            "fax_number": "206-780-5654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKLUND",
        "first_name": "LANCE",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2017-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "WA9320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• White Pine Physical Therapy PLLC
• Danelle Whitmore, MA, LMFTA
• Lauren Whittaker, DC
• Scott Bernard Whittaker, LMP, RC
• Wicklund Dental,
• Sandra K Wieland, PHD, ARNP
• Wild Foxgloves Counseling, PLLC
• Margaret Ann Wilder, LMP
• Lauren Kay Wilson, PTA
• Wings Services PLLC

• General Practice Dentistry in Bainbridge Island, WA
• Providers in Bainbridge Island, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.