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General NPI Number Information
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NPI Number | 1306235288
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Entity Type | Organization
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Legal Business Name | BEVERLY A. M. WITHAM, D.D.S., INC.
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 333 W MAUDE AVE STE 107
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City | SUNNYVALE
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State | CA
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Zip | 94085-4367
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Country | US
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Telephone | 408-739-5600
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Fax | 408-739-0160
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Provider Business Mailing Address
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Address Line | 333 W MAUDE AVE STE 107
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City | SUNNYVALE
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State | CA
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Zip | 94085-4367
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Country | US
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Telephone | 408-739-5600
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Fax | 408-739-0160
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Authorized Official
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Title or Position | PRESIDENT/OWNER/DENTIST
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Name | DR. BEVERLY ANN MCCALL WITHAM
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Credential | DDS
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Telephone | 408-739-5600
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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 | 34794
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License Number State | CA
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