Provider Demographics
NPI:1730188590
Name:MESSINGER, ERIC PETER (DDS)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:PETER
Last Name:MESSINGER
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 1:2016 NE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-1705
Mailing Address - Country:US
Mailing Address - Phone:360-834-3533
Mailing Address - Fax:360-834-7765
Practice Address - Street 1:2016 NE 3RD AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-1705
Practice Address - Country:US
Practice Address - Phone:360-834-3533
Practice Address - Fax:360-834-7765
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA55971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5024732Medicaid