Active NPI
Peter Lubisich, DDS
- Pediatric Dentistry
- Vancouver, WA
National Provider Identifier
1396756029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 4438
- Practice address
- 300 SE 120TH Ave Ste 100
Vancouver, WA 98683-4067 - Phone
- (360) 256-1755
- Fax
- (360) 882-8080
- NPI assigned
- Aug 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 4438 | WA | Primary |
Addresses
Primary practice location
300 SE 120TH Ave Ste 100
Vancouver, WA 98683-4067
Mailing address
300 SE 120TH Ave Ste 100
Vancouver, WA 98683-4067
Phone (360) 256-1755
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3798 | Other | WA | WDS ID |
| 409293 | Other | WA | UNITED CONCORDIA/TRICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4438 | WA | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lubisich & Lubisich, PLLC | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Dentistry
- Vancouver, WA
- NPI 1912228073
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396756029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 SE 120TH AVE STE 100",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986834067",
"telephone_number": "360-256-1755",
"fax_number": "360-882-8080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 SE 120TH AVE STE 100",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986834067",
"telephone_number": "360-256-1755",
"fax_number": "360-882-8080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUBISICH",
"first_name": "PETER",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "WA",
"license": "4438",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WDS ID",
"identifier": "3798",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA/TRICARE",
"identifier": "409293",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.