MEDICARE: DR. GARDNER LEONARD BEALE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	25479	CA

General Provider Information

NPI Number	:	1295971000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARDNER LEONARD BEALE DDS

Provider Business Mailing Address
First Line	:	8930 S SEPULVEDA BLVD STE 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3624
Country	:	US
Telephone Number	:	310-641-9233
Fax Number	:	310-641-7873

Provider Business Practice Location Address
First Line	:	8930 S SEPULVEDA BLVD STE 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3624
Country	:	US
Telephone Number	:	310-641-9233
Fax Number	:	310-641-7873

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2008
Last Update Date	:	12/29/2008

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