MEDICARE: KOUTSOUMBAS & LINTAKOON DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	DE60229140	WA

General Provider Information

NPI Number	:	1174975338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOUTSOUMBAS & LINTAKOON DDS PLLC

Provider Business Mailing Address
First Line	:	4055 21ST AVE W STE 101
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-1247
Country	:	US
Telephone Number	:	206-285-1338
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 21ST AVE W STE 101
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-1247
Country	:	US
Telephone Number	:	206-285-1338
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	JOHN HUNG LINTAKOON
Credential	:	DDS
Telephone Number	:	512-680-5571

Provider Enumeration Date	:	07/12/2016
Last Update Date	:	07/12/2016

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