Provider Demographics
NPI:1528413291
Name:BEACHSIDE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BEACHSIDE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RANSOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-764-3850
Mailing Address - Street 1:6645 GLENEDEN BEACH LOOP
Mailing Address - Street 2:
Mailing Address - City:GLENEDEN BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97388-9700
Mailing Address - Country:US
Mailing Address - Phone:541-764-3850
Mailing Address - Fax:541-764-3852
Practice Address - Street 1:6645 GLENEDEN BEACH LOOP
Practice Address - Street 2:
Practice Address - City:GLENEDEN BEACH
Practice Address - State:OR
Practice Address - Zip Code:97388-9700
Practice Address - Country:US
Practice Address - Phone:541-764-3850
Practice Address - Fax:541-764-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty