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General NPI Number Information
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NPI Number | 1003284134
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Entity Type | Organization
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Legal Business Name | PACIFIC NORTHWEST DENTAL ANESTHESIA SERVICES LLC
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Dates
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Enumeration Date | 09/06/2015
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Last Update Date | 09/06/2015
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Provider Practice Location Address
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Address Line | 9004 W SHOREWOOD DR APT 519
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City | MERCER ISLAND
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State | WA
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Zip | 98040-3245
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Country | US
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Telephone | 425-214-3960
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Fax |
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Provider Business Mailing Address
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Address Line | 9004 W SHOREWOOD DR APT 519
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City | MERCER ISLAND
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State | WA
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Zip | 98040-3245
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Country | US
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Telephone | 425-214-3960
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEOFFREY TIMOTHY BEAN
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Credential | DDS
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Telephone | 425-214-3960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | GA60587955
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License Number State | WA
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