Healthcare Provider Details

I. General information

NPI: 1174642284
Provider Name (Legal Business Name): ROY M. BEAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 INDIANA AVE SUITE # 9
RIVERSIDE CA
92506-4100
US

IV. Provider business mailing address

7001 INDIANA AVE SUITE # 9
RIVERSIDE CA
92506-4100
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-0093
  • Fax: 951-782-0096
Mailing address:
  • Phone: 951-782-0093
  • Fax: 951-782-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number42721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: