| 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 |
|---|---|
| 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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