NPIMap

Organization Active NPI

Lubisich & Lubisich, PLLC

  • Pediatric Dentistry
  • Vancouver, WA
National Provider Identifier
1912228073
Registry record updated Jun 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
4438 Issued in WA
Legal business name
LUBISICH & LUBISICH, PLLC
Doing business as
Vancouver Pediatric Dentistry
Practice address
300 SE 120TH Ave
Suite 100
Vancouver, WA 98683-4090
Phone
(360) 256-1755
Fax
(360) 882-8080
NPI assigned
Jun 11, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2010

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

Authorized official

Name
Peter Lubisich IV
Title
Owner
Phone
(360) 256-1755

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 4438 WA Primary

Addresses

Primary practice location

300 SE 120TH Ave
Suite 100
Vancouver, WA 98683-4090

Mailing address

300 SE 120TH Ave
Suite 100
Vancouver, WA 98683-4090
Phone (360) 256-1755

Other identifiers 3

IdentifierTypeStateIssuer
5049481MedicaidWA
5055413MedicaidWA
5046941MedicaidWA

Other names 1

  • Vancouver Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

300 SE 120th Ave
Ste 100
Vancouver, WA 98683
Phone (360) 256-1755

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1276214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276214400000",
    "number": "1912228073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SE 120TH AVE",
            "address_2": "SUITE 100",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986834090",
            "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",
            "address_2": "SUITE 100",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986834090",
            "telephone_number": "360-256-1755",
            "fax_number": "360-882-8080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUBISICH & LUBISICH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-11",
        "last_updated": "2010-06-11",
        "status": "A",
        "authorized_official_last_name": "LUBISICH",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-256-1755",
        "authorized_official_name_suffix": "IV"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "4438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5049481",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5055413",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5046941",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vancouver Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 11, 2010; 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.