Individual
PETER LUBISICH IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
300 SE 120TH AVE, SUITE 100, VANCOUVER, WA 98683-4090
(360) 256-1755
(360) 882-8080
Mailing address
300 SE 120TH AVE, SUITE 100, VANCOUVER, WA 98683-4090
(360) 256-1755
(360) 882-8080
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
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