Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DR61068986 | WA |
NPI | 1225665961 |
---|---|
Provider Name | Thomas Beckstrom |
First Address | Seattle, WA 98195-7134 |
Second Address | Seattle, WA 98195-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2020 |
Last Update Date | 11/07/2020 |