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General NPI Number Information
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NPI Number | 1790935856
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Entity Type | Organization
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Legal Business Name | DONALD J. BEKEDAM, D.D.S., INC.
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 2665 ALABAMA ST
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City | ATWATER
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State | CA
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Zip | 95301-2908
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Country | US
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Telephone | 209-358-1577
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Fax | 209-358-7419
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Provider Business Mailing Address
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Address Line | 2665 ALABAMA ST
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City | ATWATER
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State | CA
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Zip | 95301-2908
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Country | US
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Telephone | 209-358-1577
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Fax | 209-358-7419
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONALD J. BEKEDAM
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Credential | D.D.S.
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Telephone | 209-358-1577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 23474
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License Number State | CA
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