Provider Demographics
NPI:1659590206
Name:PESTER, EUGENE BENJAMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:BENJAMIN
Last Name:PESTER
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 1:317 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1948
Mailing Address - Country:US
Mailing Address - Phone:509-764-5399
Mailing Address - Fax:509-765-4757
Practice Address - Street 1:317 S ASH ST
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1948
Practice Address - Country:US
Practice Address - Phone:509-764-5399
Practice Address - Fax:509-765-4757
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000077581223G0001X
WAGA100003341223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5024930Medicaid