MEDICARE: MS. DEBORAH LORENE BEATY 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	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1689846495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH LORENE BEATY DDS

Provider Business Mailing Address
First Line	:	111 N. WABASH AVE. SUITE 1921
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602
Country	:	US
Telephone Number	:	312-332-4424
Fax Number	:	312-332-4423

Provider Business Practice Location Address
First Line	:	111 N WABASH AVE STE 1921
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-2970
Country	:	US
Telephone Number	:	312-332-4424
Fax Number	:	312-332-4423

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

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	04/01/2008

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