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General NPI Number Information
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NPI Number | 1609866888
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Entity Type | Individual
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Provider Name | JEFFREY D. BEAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 02/13/2009
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Provider Practice Location Address
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Address Line | 1144 SONOMA AVE ST. 102
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City | SANTA ROSA
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State | CA
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Zip | 95405-4812
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Country | US
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Telephone | 707-542-4414
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Fax | 707-542-4415
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Provider Business Mailing Address
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Address Line | 1144 SONOMA AVENUE ST. 102
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City | SANTA ROSA
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State | CA
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Zip | 95405-4802
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Country | US
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Telephone | 707-542-4414
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 29800
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License Number State | CA
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