Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DE60558117 | WA |
N | 1223D0004X | Dentist Anesthesiologist | DE60558117 | WA |
NPI | 1699169060 |
---|---|
Provider Name | Dr. Geoffrey T Bean |
First Address | Redmond, WA 98052-7202 |
Second Address | Redmond, WA 98052-7202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2015 |
Last Update Date | 15/05/2015 |