Eric Ross Gustavsen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00008037 Issued in WA

Practice address

1129 South 2ND Ave
Suite a
Walla Walla, WA 99362

Phone

(509) 522-2522

Fax

(509) 522-0467

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gibree, Quirt, Mongrain, P.C.

  dba Southpoint Dental Center

  • General Practice Dentistry
  • Walla Walla, WA
  • NPI 1942978986
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457431025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 SOUTH 2ND AVE",
            "address_2": "SUITE A",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "99362",
            "telephone_number": "509-522-2522",
            "fax_number": "509-522-0467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 SOUTH 2ND AVE",
            "address_2": "SUITE A",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "99362",
            "telephone_number": "509-522-2522",
            "fax_number": "509-522-0467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAVSEN",
        "first_name": "ERIC",
        "middle_name": "ROSS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00008037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON DENTAL",
            "identifier": "58037",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erik C Gryler, M.D.
• Kimberly K Guirl, OTR/L
• Jordan Gull
• Frederick John Gunningham, MD
• Linda A Gunshefski, MD
• Christy Dawn Guthrie
• Delia Gutierrez, MHT
• Guy F Gehling MD PS
• Ann Gwinn
• Man Ha

• General Practice Dentistry in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.