Provider Demographics
NPI:1619071156
Name:LUBISICH, ERINNE BISSONNETTE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERINNE
Middle Name:BISSONNETTE
Last Name:LUBISICH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SE 120TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4090
Mailing Address - Country:US
Mailing Address - Phone:360-256-3570
Mailing Address - Fax:360-896-0267
Practice Address - Street 1:300 SE 120TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4090
Practice Address - Country:US
Practice Address - Phone:360-256-3570
Practice Address - Fax:360-896-0267
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000101871223G0001X
CA537181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice