Provider Demographics
NPI:1154422756
Name:LINGENBRINK, PAUL (DDS MDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:LINGENBRINK
Suffix:
Gender:M
Credentials:DDS MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3078 E WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7621
Mailing Address - Country:US
Mailing Address - Phone:360-509-0146
Mailing Address - Fax:
Practice Address - Street 1:3078 E WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7621
Practice Address - Country:US
Practice Address - Phone:360-509-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000068681223X0400X
UT6183748-99261223X0400X
AZD0097911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics