Provider Demographics
NPI:1396079141
Name:GOERIG, DAVID CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:GOERIG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 LILLY RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-6954
Mailing Address - Country:US
Mailing Address - Phone:360-459-3636
Mailing Address - Fax:360-493-0343
Practice Address - Street 1:408 LILLY RD NE STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-6954
Practice Address - Country:US
Practice Address - Phone:360-459-3636
Practice Address - Fax:360-493-0343
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601023611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice