Organization
KIDS DENTAL OF CENTRALIA, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN VANBIBBER (OWNER)
(360) 736-5437
Entity
Organization
Contact information
Practice address
1611 KRESKY AVE, CENTRALIA, WA 98531-8982
(360) 736-5437
Mailing address
1611 KRESKY AVE, CENTRALIA, WA 98531-8982
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE60282727
WA
Other
Enumeration date
02/21/2014
Last updated
02/21/2014
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