Healthcare Provider Details

I. General information

NPI: 1790997799
Provider Name (Legal Business Name): DENNIS CHARLES BEESON DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4699 HAMANN PKWY
WILLOUGHBY OH
44094-5631
US

IV. Provider business mailing address

4699 HAMANN PKWY
WILLOUGHBY OH
44094-5631
US

V. Phone/Fax

Practice location:
  • Phone: 440-954-3272
  • Fax: 440-951-1246
Mailing address:
  • Phone: 440-954-3272
  • Fax: 440-951-1246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number13840
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: