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General NPI Number Information
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NPI Number | 1245650365
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Entity Type | Organization
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Legal Business Name | FIRCREST CHILDREN'S DENTISTRY
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 1501 REGENTS BLVD STE 200
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City | FIRCREST
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State | WA
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Zip | 98466-6098
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Country | US
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Telephone | 253-564-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 REGENTS BLVD STE 200
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City | FIRCREST
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State | WA
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Zip | 98466-6098
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Country | US
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Telephone | 253-564-2222
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. STEPHEN D BECK
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Credential | DMD, MS
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Telephone | 253-564-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE60140820
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License Number State | WA
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