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General NPI Number Information
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NPI Number | 1780755959
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Entity Type | Individual
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Provider Name | GREGG W. BEATY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3737 MORAGA AVE SUITE B-200
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City | SAN DIEGO
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State | CA
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Zip | 92117-5404
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Country | US
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Telephone | 858-272-7086
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Fax | 858-272-7289
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Provider Business Mailing Address
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Address Line | 3737 MORAGA AVE SUITE B-200
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City | SAN DIEGO
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State | CA
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Zip | 92117-5404
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Country | US
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Telephone | 858-272-7086
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Fax | 858-272-7289
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 034467
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 4036-015
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License Number State | WI
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