Provider Demographics
NPI:1295195741
Name:VANBIBBER HAUGHT DDS PC
Entity Type:Organization
Organization Name:VANBIBBER HAUGHT DDS PC
Other - Org Name:KIDS DENTAL AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANBIBBER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:253-537-5437
Mailing Address - Street 1:1148 72ND ST E
Mailing Address - Street 2:STE B
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-1800
Mailing Address - Country:US
Mailing Address - Phone:253-537-5437
Mailing Address - Fax:253-537-5438
Practice Address - Street 1:6344 LITTLEROCK RD SW
Practice Address - Street 2:BLDG 2
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7332
Practice Address - Country:US
Practice Address - Phone:253-537-5437
Practice Address - Fax:253-537-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602827271223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty