Provider Demographics
NPI:1225273832
Name:EUGENE PESTER DDS & ASSOCIATES
Entity type:Organization
Organization Name:EUGENE PESTER DDS & ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:TOMS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:509-536-5600
Mailing Address - Street 1:825 SHARON AVE E
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-2441
Mailing Address - Country:US
Mailing Address - Phone:509-766-9030
Mailing Address - Fax:
Practice Address - Street 1:3143 E 29TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4815
Practice Address - Country:US
Practice Address - Phone:509-536-5900
Practice Address - Fax:509-534-1015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EUGENE PESTER DDS & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000081021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty