Provider Demographics
NPI:1558493882
Name:WASHINGTON, ERIC TALIAFERRO (DDS)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:TALIAFERRO
Last Name:WASHINGTON
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 1:4500 HUGH HOWELL ROAD
Mailing Address - Street 2:SUITE 710
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:678-534-0573
Mailing Address - Fax:678-534-0574
Practice Address - Street 1:4500 HIUGH HOWELL RD
Practice Address - Street 2:SUITE 710
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:678-534-0573
Practice Address - Fax:678-534-0574
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist