Healthcare Provider Details

I. General information

NPI: 1548304033
Provider Name (Legal Business Name): GERRARDA C. O'BEIRNE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 06/19/2008
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 Code1223P0300X
TaxonomyPeriodontics
License Number7333
License Number StateWA

VIII. Authorized Official

Name: DR. GERRARDA CONCEPTA O'BEIRNE
Title or Position: PERIODONTIST
Credential: DDS, MSD
Phone: 206-628-0404