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General NPI Number Information
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NPI Number | 1598295156
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Entity Type | Organization
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Legal Business Name | LUBISICH & LUBISICH DMD PLLC
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Dates
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Enumeration Date | 06/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 805 NE 98TH CIR STE 100
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City | VANCOUVER
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State | WA
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Zip | 98665-9134
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Country | US
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Telephone | 360-907-3849
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Fax | 360-882-8080
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Provider Business Mailing Address
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Address Line | 805 NE 98TH CIR STE 100
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City | VANCOUVER
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State | WA
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Zip | 98665-9134
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Country | US
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Telephone | 360-907-3849
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Fax | 360-882-8080
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JOSEF WILLIAM LUBISICH
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Credential | D.M.D., M.S.
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Telephone | 360-694-9337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3764
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License Number State | WA
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