Healthcare Provider Details

I. General information

NPI: 1861143497
Provider Name (Legal Business Name): BEDDAWI, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 GRANT RD STE 202
MOUNTAIN VIEW CA
94040-3877
US

IV. Provider business mailing address

2204 GRANT RD STE 202
MOUNTAIN VIEW CA
94040-3877
US

V. Phone/Fax

Practice location:
  • Phone: 650-800-9414
  • Fax: 650-800-9460
Mailing address:
  • Phone: 650-800-9414
  • Fax: 650-800-9460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: YARAH BEDDAWI
Title or Position: PRESIDENT
Credential: DDS
Phone: 650-800-9414