1477838308 NPI number — DR. JOHN HARLO BESCHENBOSSEL DDS

Table of content: DR. JOHN HARLO BESCHENBOSSEL DDS (NPI 1477838308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477838308 NPI number — DR. JOHN HARLO BESCHENBOSSEL DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BESCHENBOSSEL
Provider First Name:
JOHN
Provider Middle Name:
HARLO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477838308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5225 WISCONSIN AVE NW
Provider Second Line Business Mailing Address:
SUITE 511
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20015-2014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-966-0620
Provider Business Mailing Address Fax Number:
202-966-1509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5225 WISCONSIN AVE NW
Provider Second Line Business Practice Location Address:
SUITE 511
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20015-2014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-966-0620
Provider Business Practice Location Address Fax Number:
202-966-1509
Provider Enumeration Date:
10/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2904 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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