Provider Demographics
NPI:1407064082
Name:OFFICE ANESTHESIA & DENTAL SURGERY
Entity Type:Organization
Organization Name:OFFICE ANESTHESIA & DENTAL SURGERY
Other - Org Name:EUGENE PESTER DDS & MARVIN GEE DDS
Other - Org Type:Other Name
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:509-536-5900
Mailing Address - Street 1:3143 E 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4815
Mailing Address - Country:US
Mailing Address - Phone:509-536-5900
Mailing Address - Fax:509-534-1015
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7134356Medicaid