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General NPI Number Information
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NPI Number | 1851110746
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Entity Type | Organization
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Legal Business Name | LANDON KING DDS JUSTIN VANBIBBER DMD PLLC
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 17415 PACIFIC AVE S STE AB
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City | SPANAWAY
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State | WA
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Zip | 98387-8200
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Country | US
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Telephone | 360-907-9662
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 NW JASMINE ST
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City | CAMAS
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State | WA
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Zip | 98607-4403
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Country | US
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Telephone | 801-231-6682
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LANDON KING
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Credential | DDS
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Telephone | 360-907-9662
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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 |
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License Number State |
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