Provider Demographics
NPI:1245683994
Name:BECKHAM, CARTER DANIEL (DMD)
Entity type:Individual
Prefix:DR
First Name:CARTER
Middle Name:DANIEL
Last Name:BECKHAM
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 1:7436 S 116TH PL
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-3030
Mailing Address - Country:US
Mailing Address - Phone:765-413-1076
Mailing Address - Fax:
Practice Address - Street 1:2045 WESTLAKE AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2605
Practice Address - Country:US
Practice Address - Phone:765-413-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61116547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist