Healthcare Provider Details

I. General information

NPI: 1518949247
Provider Name (Legal Business Name): GERRARDA CONCEPTA O'BEIRNE B.D.S.,M.S.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 OLIVE WAY SUITE 810
SEATTLE WA
98101-1878
US

IV. Provider business mailing address

720 OLIVE WAY SUITE 810
SEATTLE WA
98101-1878
US

V. Phone/Fax

Practice location:
  • Phone: 206-628-0404
  • Fax: 206-628-0024
Mailing address:
  • Phone: 206-628-0404
  • Fax: 206-628-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7333
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: