Provider Demographics
NPI:1861814980
Name:ROBERT M. GOTTLIEB, DDS, PS
Entity Type:Organization
Organization Name:ROBERT M. GOTTLIEB, DDS, PS
Other - Org Name:IMPLANT & PERIODONTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-486-9111
Mailing Address - Street 1:5723 NE BOTHELL WAY STE C
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-9404
Mailing Address - Country:US
Mailing Address - Phone:425-486-9111
Mailing Address - Fax:
Practice Address - Street 1:140 GAGE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-8916
Practice Address - Country:US
Practice Address - Phone:509-542-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental