MEDICARE: JOHN C BEATY DDS, FAMILY DENTISTRY

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

General Provider Information

NPI Number	:	1881612240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN C BEATY DDS, FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	113 N BANANA RIVER DR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-2546
Country	:	US
Telephone Number	:	321-452-8334
Fax Number	:	321-452-8335

Provider Business Practice Location Address
First Line	:	113 N BANANA RIVER DR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-2546
Country	:	US
Telephone Number	:	321-452-8334
Fax Number	:	321-452-8335

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN C BEATY
Credential	:	DDS
Telephone Number	:	321-452-8334

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	08/22/2020

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