Organization
PEDIATRIC DENTAL CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN L. GIBBONS D.M.D. (DOCTOR)
(253) 627-6023
Entity
Organization
Contact information
Practice address
316 MARTIN LUTHER KING JR WAY STE 209, TACOMA, WA 98405-4254
(253) 627-6023
(253) 627-4035
Mailing address
316 MARTIN LUTHER KING JR WAY STE 209, TACOMA, WA 98405-4254
(253) 627-6023
(253) 627-4035
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DE05994
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5000823
—
WA
Enumeration date
06/30/2008
Last updated
06/30/2008
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