Healthcare Provider Details

I. General information

NPI: 1114718897
Provider Name (Legal Business Name): BEOLINE UWAMPAMO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5735 MEEKER RD
GREENVILLE OH
45331-1186
US

IV. Provider business mailing address

5735 MEEKER RD
GREENVILLE OH
45331-1186
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-9680
  • Fax:
Mailing address:
  • Phone: 937-548-9680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.027954
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: