Healthcare Provider Details

I. General information

NPI: 1992856603
Provider Name (Legal Business Name): ERIC J OPSVIG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 EAST NORTH BEND WAY
NORTH BEND WA
98045
US

IV. Provider business mailing address

POST OFFICE BOX 1640
NORTH BEND WA
98045
US

V. Phone/Fax

Practice location:
  • Phone: 425-888-8688
  • Fax: 425-888-8690
Mailing address:
  • Phone: 425-888-8688
  • Fax: 425-888-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6100
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: