Provider Demographics
NPI:1992880108
Name:WITHAM, BEVERLY ANN MCCALL (DDS)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ANN MCCALL
Last Name:WITHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W MAUDE AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4367
Mailing Address - Country:US
Mailing Address - Phone:408-739-5600
Mailing Address - Fax:408-739-0160
Practice Address - Street 1:333 W MAUDE AVE STE 107
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4367
Practice Address - Country:US
Practice Address - Phone:408-739-5600
Practice Address - Fax:408-739-0160
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice