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SMILES 4 KIDS LACEY, P.C.

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Company Details

Legal Name: SMILES 4 KIDS LACEY, P.C.
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL SERVICE CORPORATION
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: December 12th 2013
Expiration date: 31 Dec 2025
UBI Number: 603 357 700
ZIP code: 98503
City: Lacey
County: THURSTON
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 909 SLEATER-KINNEY RD SE, SUITE 3, LACEY, WA, 98503, UNITED STATES
Supporting healthcare providers fighting with COVID-19: $76,573

Contact Details

E-Mail: CLS-CTARMSEVIDENCE@WOLTERSKLUWER.COM

Nature of Business

PEDIATRIC DENTISTRY

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Registered Agent Information

Name Role Address
C T CORPORATION SYSTEM Registered Agent 711 CAPITOL WAY S STE 204, OLYMPIA, WA, 98501-1267, UNITED STATES

Key Officers & Management

Name Role
JUSTIN VANBIBBER Governing Person

National Provider Identifier

NPI Number:
1982026407
Certification Date:
2021-07-06

Authorized Person:

Name:
MADISON LEHMAN
Role:
CREDENTIALING SPECIALIST
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

OSHA's Inspections within Industry

Inspection Summary

Date:
2014-12-17
Type:
Referral
Address:
909 SLEATER KINNEY RD SE STE 3, LACEY, WA, 98503
Safety Health:
Health
Scope:
Complete
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