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General NPI Number Information
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NPI Number | 1558709378
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Entity Type | Individual
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Provider Name | DESTINY BEAN DDS
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Gender | Female
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Dates
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Enumeration Date | 06/13/2013
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 15889 PRESTON RD APT 1130
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City | DALLAS
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State | TX
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Zip | 75248-3811
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Country | US
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Telephone | 210-347-1323
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Fax |
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Provider Business Mailing Address
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Address Line | 15889 PRESTON RD APT 1130
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City | DALLAS
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State | TX
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Zip | 75248-3811
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Country | US
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Telephone | 210-347-1323
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 28905
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 058426
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License Number State | NY
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