Healthcare Provider Details

I. General information

NPI: 1922704329
Provider Name (Legal Business Name): BEULAH ROAD DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8716 BEULAH RD
PENSACOLA FL
32526-5326
US

IV. Provider business mailing address

8716 BEULAH RD
PENSACOLA FL
32526-5326
US

V. Phone/Fax

Practice location:
  • Phone: 850-706-5688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ETHAN SADOWSKI
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 850-706-5688