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General NPI Number Information
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NPI Number | 1659565794
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Entity Type | Individual
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Provider Name | ROY M. BEALS I D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 12444 VICTORY BLVD SUITE 102
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3199
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Country | US
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Telephone | 818-763-4367
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Fax | 818-769-6943
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Provider Business Mailing Address
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Address Line | 12444 VICTORY BLVD SUITE 102
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3199
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Country | US
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Telephone | 818-763-4367
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Fax | 818-769-6943
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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 | 21849
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License Number State | CA
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