Provider Demographics
NPI:1477675007
Name:GOERIG, ALBERT CHARLES (BS,DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:CHARLES
Last Name:GOERIG
Suffix:
Gender:M
Credentials:BS,DDS,MS
Other - Prefix:DR
Other - First Name:ALBERT
Other - Middle Name:CHARLES
Other - Last Name:GOERIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:222 LILLY RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-6103
Mailing Address - Country:US
Mailing Address - Phone:360-459-3636
Mailing Address - Fax:
Practice Address - Street 1:222 LILLY RD NE STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-6103
Practice Address - Country:US
Practice Address - Phone:360-459-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA40811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics