Provider Demographics
NPI:1871947424
Name:VANBIBBER WENATCHEE PC
Entity type:Organization
Organization Name:VANBIBBER WENATCHEE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:L
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:STE 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 1:650 N MILLER ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2044
Practice Address - Country:US
Practice Address - Phone:509-662-3621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60282727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty