Provider Demographics
NPI:1235346057
Name:EUGENE PESTER DDS & ASSOCIATES
Entity Type:Organization
Organization Name:EUGENE PESTER DDS & ASSOCIATES
Other - Org Name:MOSES LAKE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:B
Authorized Official - Last Name:PESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-995-7746
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:509-766-5624
Practice Address - Street 1:825 SHARON AVE E
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2441
Practice Address - Country:US
Practice Address - Phone:509-766-9030
Practice Address - Fax:509-766-5624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5044599Medicaid