Organization
WICKLUND DENTAL,
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LANCE F WICKLUND DMD (OWNER)
(206) 842-6624
Entity
Organization
Contact information
Practice address
9723 COPPERTOP LOOP NE, STE 101, BAINBRIDGE ISLAND, WA 98110-3699
(206) 842-6624
(206) 780-5654
Mailing address
9723 COPPERTOP LOOP NE, STE 101, BAINBRIDGE ISLAND, WA 98110-3699
(206) 842-6624
(206) 780-5654
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
WA9320
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1831267947
GENERAL DENTIST
WA
Enumeration date
08/24/2016
Last updated
08/24/2016
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