Healthcare Provider Details

I. General information

NPI: 1902295546
Provider Name (Legal Business Name): MISCHELLE BEELER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 COLUMBUS RD
ATHENS OH
45701-1335
US

IV. Provider business mailing address

207 COLUMBUS RD
ATHENS OH
45701-1335
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-8530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31.008320
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: