=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528573870
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTOPHER B BESSEY, DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2017
-----------------------------------------------------
Last Update Date | 12/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12116 SE MILL PLAIN BLVD STE 3
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98684-6000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-256-8200
-----------------------------------------------------
Fax | 360-256-9356
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12116 SE MILL PLAIN BLVD STE 3
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98684-6000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-256-8200
-----------------------------------------------------
Fax | 360-256-9356
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | CHRISTOPHER BRETT BESSEY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 360-949-5171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | DE60754754
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------