| NPI | 1790947778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN L. GIBBONS Doctor 253-627-6023 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA de05994) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2008-06-30 |