Healthcare Provider Details

I. General information

NPI: 1205945581
Provider Name (Legal Business Name): MICHAEL RAYMOND BEERS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15320 SPENCERVILLE CT STE 101
BURTONSVILLE MD
20866-1642
US

IV. Provider business mailing address

15320 SPENCERVILLE CT STE 101
BURTONSVILLE MD
20866-1642
US

V. Phone/Fax

Practice location:
  • Phone: 301-421-4041
  • Fax: 310-421-4146
Mailing address:
  • Phone: 301-421-4041
  • Fax: 310-421-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9961
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: