DR. PETER LUBISICH (NPI# 1396756029) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396756029 |
| Entity Type | Individual |
| Full Name | DR. PETER LUBISICH |
| Credential | DDS |
| Practice Address |
300 Se 120th Ave Ste 100 Vancouver WA 98683-4067 |
| Practice Telephone | 3602561755 |
| Practice Fax Number | 3608828080 |
| Mailing Telephone | 3602561755 |
| Mailing Fax Number | 3608828080 |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
4438 | WA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | WDS ID | 3798 | 01 |
| WA | UNITED CONCORDIA/TRICARE | 409293 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760703821 | Peter Lubisich Iv | Dentist | 300 Se 120th Ave, Suite 100, Vancouver, WA 98683-4090 | 2010-06-11 |
| Street Address |
300 SE 120TH AVE STE 100 |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98683-4067 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235761222 | Nathaniel James Eugene Powell | Behavior Technician | 4101se 192nd Ave, Ste 101, Vancouver, WA 98683 | 2020-02-07 |
| 1295294973 | Ubmhc1, LLC | Clinical Medical Laboratory | 18110 Southeast 34th St, Building 2, Suite 240, Vancouver, WA 98683 | 2019-03-13 |
| 1982116695 | Amy K Adams | Massage Therapist | 2716 Se 169th Ave, X-232, Vancouver, WA 98683 | 2017-11-03 |
| 1477088920 | Alexandra Ransonet | Dental Hygienist | 19111 Se 34th. St., Vancouver, WA 98683 | 2017-04-21 |
| 1639618630 | Digestive Gi Care | Internal Medicine | 305 Sw Chkalov Dr, 111-140, Vancouver, WA 98683 | 2017-02-23 |
| 1447706742 | Jennifer Horst | Massage Therapist | 3401 Se 192nd. Ave. Suite 107, Vancouver, WA 98683 | 2016-08-28 |
| 1154702728 | Kacie Marie Hamreus | Physician Assistant | 3101 Se 192nd Avenue, Vancouver, WA 98683 | 2015-06-09 |
| 1851782338 | Kathryn Wiedeman | Physical Therapy Assistant | 801 Se Park Crestt Ave, Vancouver, WA 98683 | 2015-02-05 |
| 1407255326 | Jesse Ryan Moses | Dentist | 16600 Se 15th Street, Suite A, Vancouver, WA 98683 | 2014-08-15 |
| 1366869893 | Stephen J Wold II | Podiatrist | 16701 Ne Mcgillivray Blvd, Ste 220, Vancouver, WA 98683 | 2014-03-21 |
| Find all providers in zip 98683 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043563661 | Amna Shebani, D.d.s., P.C. | Dentist | 1405 S.e. 164th Avenue, Suite # 203, Vancouver, WA 98683 | 2012-10-19 |
| 1336436906 | Justin Anthony Heaton | Dentist | 900 Ne 139th St Ste 106, Vancouver, WA 98685 | 2011-07-05 |
| 1285798728 | Frank J Foreman Dds Ps | Dentist | 11700 Ne 95th St, Suite 120, Vancouver, WA 98682-2399 | 2006-12-20 |
| 1841353638 | Richard L. Grabowsky | Dentist | 1933 Fort Vancouver Way, Vancouver, WA 98663-3529 | 2006-12-19 |
| 1093891533 | Willie M Hardie | Dentist | 925 Ne 136th Ave, Suite 101, Vancouver, WA 98684-0896 | 2006-10-27 |
| 1255348181 | David S Neil | Dentist | 2501 Ne 134th St, Vancouver, WA 98686-3026 | 2006-08-02 |
| 1801831508 | Pamela Butler | Dentist | 3205 Se 192nd Ave, Suite#100, Vancouver, WA 98683 | 2006-06-17 |
| 1396134185 | Renato De Luna, Dmd | Dentist | 11700 Ne 95th St, Suite 120, Vancouver, WA 98682-2399 | 2015-01-15 |
| 1033460183 | Gagneja, Bds, Pllc | Dentist | 601 Se 117th Ave, Ste 150, Vancouver, WA 98683-5297 | 2012-09-28 |
| 1285998336 | Kurt Duc Truong | Dentist | 14201 Ne 20th Ave, #c-3102, Vancouver, WA 98686-6410 | 2012-07-03 |
| Find all providers in VANCOUVER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.