Provider Demographics
NPI:1831864727
Name:GARIBOV, PLLC
Entity type:Organization
Organization Name:GARIBOV, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARIBOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:360-513-6244
Mailing Address - Street 1:3820 READING ST SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3084
Mailing Address - Country:US
Mailing Address - Phone:360-513-6244
Mailing Address - Fax:
Practice Address - Street 1:9300 NE VANCOUVER MALL DR STE 205
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-8201
Practice Address - Country:US
Practice Address - Phone:360-524-4236
Practice Address - Fax:360-397-6867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty