| NPI | 1639536097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN L VANBIBBER Owner 253-537-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60282727) |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2016-01-15 |