Provider Demographics
NPI:1669025680
Name:BEETHAM, RYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:BEETHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 LINCOLN STREET, 2ND FLOOR, ATTN: CREDENTIAL OFFICE
Mailing Address - Street 2:US ARMY DENTAC
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98327
Mailing Address - Country:US
Mailing Address - Phone:253-968-4079
Mailing Address - Fax:253-968-5919
Practice Address - Street 1:US ARMY DENTAC
Practice Address - Street 2:9900 LINCOLN STREET, 2ND FLOOR
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98327
Practice Address - Country:US
Practice Address - Phone:253-968-4079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program