Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DE60140820 | WA |
NPI | 1033368006 |
---|---|
Provider Name | Dr. Stephen David Beck |
First Address | Fircrest, WA 98466-6098 |
Second Address | Fircrest, WA 98466-6098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2008 |
Last Update Date | 03/11/2010 |