Individual
CARSON BEATY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2103 N DIVISION ST, TACOMA, WA 98433
(253) 967-3416
Mailing address
2103 N DIVISION ST, TACOMA, WA 98433
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE61327566
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE61327566
WASHINGTON DENTAL LICENSE
—
Enumeration date
07/22/2022
Last updated
07/22/2022
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