Kids Dental of Centralia, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60282727 Issued in WA

Legal business name

KIDS DENTAL OF CENTRALIA, P.C.

Practice address

1611 Kresky Ave
Centralia, WA 98531-8982

Phone

(360) 736-5437

NPI assigned

Feb 21, 2014

Organization subpart

No

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

Authorized official

Name

Justin Vanbibber

Title

Owner

Phone

(360) 736-5437

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1392940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392940800000",
    "number": "1659796076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 KRESKY AVE",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985318982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 KRESKY AVE",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985318982",
            "telephone_number": "360-736-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS DENTAL OF CENTRALIA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-21",
        "last_updated": "2014-02-21",
        "status": "A",
        "authorized_official_last_name": "VANBIBBER",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-736-5437"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60282727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Centralia, WA
• Providers in Centralia, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2014; 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.