# LAKE SAMMAMISH FAMILY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093036709
- **Authorized official:** ANNA LISIN DDS (DENTIST)
- **Authorized official phone:** (425) 392-3900

## Contact information

- **Practice address:** 5712 E LAKE SAMMAMISH PKWY SE, STE 108, ISSAQUAH, WA 98029-8943
- **Practice address phone:** (425) 392-3900
- **Mailing address:** 5712 E LAKE SAMMAMISH PKWY SE, STE 108, ISSAQUAH, WA 98029-8943
- **Mailing address phone:** (425) 392-3900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 60065361 | WA | Yes |

## Other

- **Enumeration date:** 06/16/2010
- **Last updated:** 06/16/2010