Provider Demographics
NPI:1548637630
Name:WHITEAKER, BEECHER C III
Entity type:Individual
Prefix:
First Name:BEECHER
Middle Name:C
Last Name:WHITEAKER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL HOSPITAL OAK HBR
Mailing Address - Street 2:3475 N SARATOGA STREET
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98278-8800
Mailing Address - Country:US
Mailing Address - Phone:360-257-2302
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL OAK HBR
Practice Address - Street 2:3475 N SARATOGA STREET
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98278-8800
Practice Address - Country:US
Practice Address - Phone:360-257-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA609911223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235690140OtherUS NAVY