Healthcare Provider Details

I. General information

NPI: 1598829764
Provider Name (Legal Business Name): JULIE SUZANNE BEASLEY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11671 JOLLYVILLE RD SUITE 201
AUSTIN TX
78759-4139
US

IV. Provider business mailing address

11671 JOLLYVILLE RD SUITE 201
AUSTIN TX
78759-4139
US

V. Phone/Fax

Practice location:
  • Phone: 512-249-7668
  • Fax: 512-219-1246
Mailing address:
  • Phone: 512-249-7668
  • Fax: 512-219-1246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number22478
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: