Provider Demographics
NPI:1295504587
Name:EYRE, JON MICHIEL (DDS)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:MICHIEL
Last Name:EYRE
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 1:1727 POINTE WOODWORTH DR NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-3480
Mailing Address - Country:US
Mailing Address - Phone:253-970-7515
Mailing Address - Fax:
Practice Address - Street 1:933 E 1ST ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-4012
Practice Address - Country:US
Practice Address - Phone:360-797-1037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA614664431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice