Healthcare Provider Details

I. General information

NPI: 1306170311
Provider Name (Legal Business Name): BEFFA DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S NORMANDY RD
BURIEN WA
98148-1708
US

IV. Provider business mailing address

124 S NORMANDY RD
BURIEN WA
98148-1708
US

V. Phone/Fax

Practice location:
  • Phone: 206-242-0066
  • Fax: 206-242-0069
Mailing address:
  • Phone: 206-242-0066
  • Fax: 206-242-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4050
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60098409
License Number StateWA

VIII. Authorized Official

Name: DR. KYLE M BEFFA
Title or Position: OWNER
Credential: DMD
Phone: 206-242-0066