MEDICARE: DR. JOSEPH VICTOR BEAN 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	1223G0001X	General Practice Dentistry	30-01-3434	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30-01-3434	OTHER	OH	DENTAL LICENSE

General Provider Information

NPI Number	:	1609902816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH VICTOR BEAN DDS

Provider Business Mailing Address
First Line	:	307 E STROOP RD
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-2827
Country	:	US
Telephone Number	:	937-299-6766
Fax Number	:	937-299-3326

Provider Business Practice Location Address
First Line	:	307 E STROOP RD
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-2827
Country	:	US
Telephone Number	:	937-299-6766
Fax Number	:	937-299-3326

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

Provider Enumeration Date	:	02/24/2007
Last Update Date	:	07/08/2007

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