Healthcare Provider Details

I. General information

NPI: 1912977893
Provider Name (Legal Business Name): DEAN BEATTY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 NIDER BLVD
NORFOLK VA
23521-2701
US

IV. Provider business mailing address

4519 REVERE DR
VIRGINIA BEACH VA
23456-4807
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN 10441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: