Provider Demographics
NPI:1518197359
Name:UNIVERSITY OF WASHINGTON DEPT OF ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:UNIVERSITY OF WASHINGTON DEPT OF ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSOR & CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:O.
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:BEIRNE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PHD
Authorized Official - Phone:206-543-7722
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:BOX 357134
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-7134
Mailing Address - Country:US
Mailing Address - Phone:206-543-7722
Mailing Address - Fax:206-685-7222
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 357134
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-7134
Practice Address - Country:US
Practice Address - Phone:206-543-7722
Practice Address - Fax:206-685-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADR 60096066282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital