NPI 1659796076

Kids Dental of Centralia, P.C.

Organisation General Practice Dentistry Centralia, WA

Practice location

Address: 1611 Kresky Ave, Centralia, WA 98531-8982
Phone: (360) 736-5437

Authorised official

Name: Justin Vanbibber
Title: Owner
Phone: (360) 736-5437

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence DE60282727 (WA)

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Registry record

NPI: 1659796076
Entity type: Organization
NPI issued: 21 Feb 2014
Record last updated: 21 Feb 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.