Healthcare Provider Details

I. General information

NPI: 1932339710
Provider Name (Legal Business Name): UNIVERSITY OF WASHINGTON ORAL & MAXILLOFACIAL SURGERY DEPT.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST BOX 357134
SEATTLE WA
98195-7134
US

IV. Provider business mailing address

1959 NE PACIFIC ST BOX 357134
SEATTLE WA
98195-7134
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-7722
  • Fax: 206-685-7222
Mailing address:
  • Phone: 206-543-7722
  • Fax: 206-685-7222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE60216311
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberDR 60096073
License Number StateWA

VIII. Authorized Official

Name: DR. O. ROSS BEIRNE
Title or Position: PROFESSOR AND CHAIR
Credential: DMD, PHD
Phone: 206-543-7722