Healthcare Provider Details

I. General information

NPI: 1295504587
Provider Name (Legal Business Name): JON MICHIEL EYRE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 12/27/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 E 1ST ST
PORT ANGELES WA
98362-4012
US

IV. Provider business mailing address

1727 POINTE WOODWORTH DR NE
TACOMA WA
98422-3480
US

V. Phone/Fax

Practice location:
  • Phone: 360-797-1037
  • Fax:
Mailing address:
  • Phone: 253-970-7515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number61466443
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: