Healthcare Provider Details

I. General information

NPI: 1033763800
Provider Name (Legal Business Name): JOSEPH ROBERT EIDSNESS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 S BURLINGTON BLVD
BURLINGTON WA
98233-1708
US

IV. Provider business mailing address

5430 91ST ST NE
MARYSVILLE WA
98270-2642
US

V. Phone/Fax

Practice location:
  • Phone: 360-707-5353
  • Fax:
Mailing address:
  • Phone: 360-618-2877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number60976118
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: