MEDICARE: DR. ERIC WILLIAM RUSTEMIER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DE60874970	WA

General Provider Information

NPI Number	:	1770061889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC WILLIAM RUSTEMIER DMD

Provider Business Mailing Address
First Line	:	3300 W MCGRAW ST STE 240
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-3246
Country	:	US
Telephone Number	:	206-880-7471
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 W MCGRAW ST STE 240
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-3246
Country	:	US
Telephone Number	:	206-880-7471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2018
Last Update Date	:	07/31/2018

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