person
Peter Lubisich IV, DMD
Pediatric Dentist in Vancouver, Washington
NPI 1760703821

Peter Lubisich IV is a Pediatric Dentist based in Vancouver, WA and is specialized in Pediatric Dentistry. Peter Lubisich IV practices in Vancouver, WA and has the professional credentials of DMD. The NPI Number for Peter Lubisich IV is 1760703821 and holds a License No. DE00009724 (Washington).

The current practice location address for Peter Lubisich IV is 300 Se 120Th Ave, Vancouver, WA and can be reached out via phone at 360-256-1755 and via fax at 360-882-8080.

Location: 300 Se 120Th Ave, Vancouver, WA, 98683-4090
person
Provider Profile Details
NPI Number
1760703821
Provider Name
Peter Lubisich IV
Credential
DMD
Provider Entity Type
Individual
Gender
Male
Address
300 Se 120Th Ave, Vancouver, WA, 98683-4090
Phone Number
360-256-1755
Fax Number
360-882-8080
Provider Enumeration Date
06/11/2010
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
DE00009724 01 WA STATE LICENSE
5046941 05 WA
institution
Provider Business Practice Location Address Details
Address
300 Se 120Th Ave
City
State
Zip
98683-4090
Phone Number
360-256-1755
Fax Number
360-882-8080
person
Provider Business Mailing Address Details
Address
300 Se 120Th Ave
City
State
Zip
98683-4090
Phone Number
360-256-1755
Fax Number
360-882-8080
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
License No.
DE00009724 (Washington)
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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