Healthcare Provider Details

I. General information

NPI: 1407847072
Provider Name (Legal Business Name): CHERI DUNHAM BEITIA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 DIVISION AVE
MORTON WA
98356-9300
US

IV. Provider business mailing address

2690 NE KRESKY AVE
CHEHALIS WA
98532-2412
US

V. Phone/Fax

Practice location:
  • Phone: 360-496-5101
  • Fax: 360-496-5123
Mailing address:
  • Phone: 360-330-9595
  • Fax: 360-330-9560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDENT.DE.00008833
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDENT.DE.00008833
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: