Healthcare Provider Details

I. General information

NPI: 1538144852
Provider Name (Legal Business Name): JEFFREY WILLIAM BEYER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 STILLMAN PKWY SUITE 101
RICHMOND VA
23233-1455
US

IV. Provider business mailing address

3800 STILLMAN PKWY SUITE 101
RICHMOND VA
23233-1455
US

V. Phone/Fax

Practice location:
  • Phone: 804-934-9292
  • Fax: 804-934-9290
Mailing address:
  • Phone: 804-934-9292
  • Fax: 804-934-9290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401008710
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: