Healthcare Provider Details

I. General information

NPI: 1134164122
Provider Name (Legal Business Name): PATRICIA BEALS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W THOMAS RD SUITE 330
PHOENIX AZ
85013-4405
US

IV. Provider business mailing address

124 W THOMAS RD SUITE 330
PHOENIX AZ
85013-4405
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3560
  • Fax: 602-406-1011
Mailing address:
  • Phone: 602-406-3560
  • Fax: 602-406-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD07044
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: