Provider Demographics
NPI:1851110746
Name:LANDON KING DDS JUSTIN VANBIBBER DMD PLLC
Entity type:Organization
Organization Name:LANDON KING DDS JUSTIN VANBIBBER DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-907-9662
Mailing Address - Street 1:3800 NW JASMINE ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-4403
Mailing Address - Country:US
Mailing Address - Phone:801-231-6682
Mailing Address - Fax:
Practice Address - Street 1:17415 PACIFIC AVE S STE AB
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8200
Practice Address - Country:US
Practice Address - Phone:360-907-9662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty