Provider Demographics
NPI:1689029688
Name:JUSTIN VANBIBBER DDS PC
Entity Type:Organization
Organization Name:JUSTIN VANBIBBER DDS PC
Other - Org Name:BURIEN CHILDREN'S DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
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:SUITE 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 1:14411 AMBAUM BLVD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1423
Practice Address - Country:US
Practice Address - Phone:206-246-4559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60282727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty