# KIDS DENTAL OF CENTRALIA, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659796076
- **Authorized official:** JUSTIN VANBIBBER (OWNER)
- **Authorized official phone:** (360) 736-5437

## Contact information

- **Practice address:** 1611 KRESKY AVE, CENTRALIA, WA 98531-8982
- **Practice address phone:** (360) 736-5437
- **Mailing address:** 1611 KRESKY AVE, CENTRALIA, WA 98531-8982

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE60282727 | WA | Yes |

## Other

- **Enumeration date:** 02/21/2014
- **Last updated:** 02/21/2014