Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 4640 | WA |
NPI | 1154389229 |
---|---|
Provider Name | Dr. William Clark Lubken |
First Address | Gig Harbor, WA 98335-1768 |
Second Address | Gig Harbor, WA 98335-1767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 26/09/2008 |