Provider Demographics
NPI:1003284134
Name:PACIFIC NORTHWEST DENTAL ANESTHESIA SERVICES LLC
Entity Type:Organization
Organization Name:PACIFIC NORTHWEST DENTAL ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-214-3960
Mailing Address - Street 1:9004 W SHOREWOOD DR
Mailing Address - Street 2:APT 519
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3245
Mailing Address - Country:US
Mailing Address - Phone:425-214-3960
Mailing Address - Fax:
Practice Address - Street 1:9004 W SHOREWOOD DR
Practice Address - Street 2:APT 519
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3245
Practice Address - Country:US
Practice Address - Phone:425-214-3960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-06
Last Update Date:2015-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAGA605879551223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Multi-Specialty