Healthcare Provider Details

I. General information

NPI: 1396079141
Provider Name (Legal Business Name): DAVID CHARLES GOERIG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 LILLY RD NE
OLYMPIA WA
98506-5031
US

IV. Provider business mailing address

222 LILLY RD NE
OLYMPIA WA
98506-5031
US

V. Phone/Fax

Practice location:
  • Phone: 360-459-3636
  • Fax: 360-493-0343
Mailing address:
  • Phone: 360-459-3636
  • Fax: 360-493-0343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE60102361
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: