| NPI | 1659796076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN VANBIBBER Owner 360-736-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60282727) |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2014-02-21 |