Healthcare Provider Details

I. General information

NPI: 1821288549
Provider Name (Legal Business Name): DRS. BEATTY & JONES, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1295 OLIVER ST
FAYETTEVILLE NC
28304-4450
US

IV. Provider business mailing address

1295 OLIVER ST
FAYETTEVILLE NC
28304-4450
US

V. Phone/Fax

Practice location:
  • Phone: 910-322-2517
  • Fax:
Mailing address:
  • Phone: 910-322-2517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6685
License Number StateNC

VIII. Authorized Official

Name: MRS. AMY LYNN ANDERSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-322-2517