Individual
DR. ERIC ROSS GUSTAVSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1129 SOUTH 2ND AVE, SUITE A, WALLA WALLA, WA 99362
(509) 522-2522
(509) 522-0467
Mailing address
1129 SOUTH 2ND AVE, SUITE A, WALLA WALLA, WA 99362
(509) 522-2522
(509) 522-0467
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00008037
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58037
WASHINGTON DENTAL
WA
Enumeration date
10/17/2006
Last updated
07/08/2007
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