Provider Demographics
NPI:1093293219
Name:JUSTIN VANBIBBER II DDS PC
Entity Type:Organization
Organization Name:JUSTIN VANBIBBER II DDS PC
Other - Org Name:HARBOR KIDS DENTAL & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL MGR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-759-5437
Mailing Address - Street 1:5401 6TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2618
Mailing Address - Country:US
Mailing Address - Phone:253-759-5437
Mailing Address - Fax:
Practice Address - Street 1:900 OCEAN BEACH HWY STE A
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4013
Practice Address - Country:US
Practice Address - Phone:253-759-5437
Practice Address - Fax:253-426-1836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60282727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty