Provider Demographics
NPI:1275836801
Name:BEATTY AND COTTAM PLLC
Entity Type:Organization
Organization Name:BEATTY AND COTTAM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:206-248-3035
Mailing Address - Street 1:15515 3RD AVE SW
Mailing Address - Street 2:#E
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2553
Mailing Address - Country:US
Mailing Address - Phone:206-248-3035
Mailing Address - Fax:206-248-1463
Practice Address - Street 1:15515 3RD AVE SW
Practice Address - Street 2:#E
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2553
Practice Address - Country:US
Practice Address - Phone:206-248-3035
Practice Address - Fax:206-248-1463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601725921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty