Healthcare Provider Details

I. General information

NPI: 1184836702
Provider Name (Legal Business Name): JOHN E. BEUMER III DDS,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

PO BOX 84582
LOS ANGELES CA
90073-0582
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-6510
  • Fax: 310-206-4201
Mailing address:
  • Phone: 310-825-6510
  • Fax: 310-206-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberD19585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: