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Organization
HARBOR KIDS DENTAL & ORTHODONTICS OF TACOMA PC
Active
Organization
HARBOR KIDS DENTAL & ORTHODONTICS OF TACOMA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN L VANBIBBER DMD (OWNER)
(253) 537-5437
Entity
Organization
Contact information
Practice address
4002 S M ST, TACOMA, WA 98418-3800
(253) 474-0606
(253) 537-5438
Mailing address
4002 S M ST, TACOMA, WA 98418-3800
(253) 474-0606
(253) 537-5438
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE60282727
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE60282727
DENTAL LICENSE
WA
Enumeration date
01/15/2016
Last updated
01/15/2016
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