Justin Lee Vanbibber, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DE60282727 Issued in WA

Practice address

1148 72ND St E Ste B
Tacoma, WA 98404-1705

Phone

(801) 231-6682

NPI assigned

Oct 26, 2010

Last updated

Sep 7, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Harbor Kids Dental PLLC

  • General Practice Dentistry
  • Aberdeen, WA
  • NPI 1851775514
  Authorized official Same address or phone
• Smiles 4 Kids PC

  • General Practice Dentistry
  • Tacoma, WA
  • NPI 1467715508
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346976000000",
    "number": "1356641161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1148 72ND ST E STE B",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984041705",
            "telephone_number": "801-231-6682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1148 72ND ST E STE B",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984041705",
            "telephone_number": "801-231-6682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANBIBBER",
        "first_name": "JUSTIN",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-26",
        "last_updated": "2012-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1855544",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "DE60282727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Marie Van Sickle, MS
• Katrina Van Strien, LMHCA, ATR-P
• Jessica Lee Van Vallis, MT
• Krysta Van Woert
• David Wayne Van Wyck, D.O.
• Natasha Vanchinathan, MD
• Vijay Vanchinathan, M.D.
• Christina Vandenberg, LMHC
• Coenraad Jacobus Vandenberg
• Richard John Vandenberg, RPH

• Pediatric Dentistry in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Pediatric Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.