Provider Demographics
NPI:1598295156
Name:LUBISICH & LUBISICH DMD PLLC
Entity Type:Organization
Organization Name:LUBISICH & LUBISICH DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEF
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LUBISICH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:360-694-9337
Mailing Address - Street 1:805 NE 98TH CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9134
Mailing Address - Country:US
Mailing Address - Phone:360-907-3849
Mailing Address - Fax:360-882-8080
Practice Address - Street 1:805 NE 98TH CIR STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-9134
Practice Address - Country:US
Practice Address - Phone:360-907-3849
Practice Address - Fax:360-882-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1326260035OtherNPI
WA1912228073OtherNPI