Pediatric Dental Care Center | |
316 Martin Luther King Jr Way Ste 209 Tacoma WA 98405-4254 | |
(253) 627-6023 | |
(253) 627-4035 |
Full Name | Pediatric Dental Care Center |
---|---|
Speciality | Dentist - Pediatric Dentistry |
Location | 316 Martin Luther King Jr Way Ste 209, Tacoma, Washington |
Authorized Official Name and Position | John L. Gibbons (DOCTOR) |
Authorized Official Contact | 2536276023 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Pediatric Dental Care Center 316 Martin Luther King Jr Way Ste 209 Tacoma WA 98405-4254 Ph: (253) 627-6023 | Pediatric Dental Care Center 316 Martin Luther King Jr Way Ste 209 Tacoma WA 98405-4254 Ph: (253) 627-6023 |
NPI Number | 1790947778 |
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Provider Enumeration Date | 06/30/2008 |
Last Update Date | 06/30/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1790947778 | NPI | - | NPPES |
5000823 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223P0221X | Dentist - Pediatric Dentistry | DE05994 (Washington) | Primary |
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