=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013798677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARGOT BEERMAN DDS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2023
-----------------------------------------------------
Last Update Date | 10/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4428 CONLIN ST SIDE B
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70006-2184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-888-9408
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4428 CONLIN ST SIDE B
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70006-2184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-888-9408
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARGOT B YOST
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 504-234-3217
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------