Individual
PETER LUBISICH IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DE00009724
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5046941
—
WA
01
—
DE00009724
STATE LICENSE
WA
Enumeration date
06/11/2010
Last updated
06/11/2010
Update your record
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