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General NPI Number Information
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NPI Number | 1861644601
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Entity Type | Organization
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Legal Business Name | CHILDRENS DENTISTRY OF BEAUMONT, P.C.
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Dates
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Enumeration Date | 10/10/2008
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 6755 PHELAN BLVD. SUITE 32
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City | BEAUMONT
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State | TX
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Zip | 77706
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Country | US
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Telephone | 409-866-8886
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Fax |
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Provider Business Mailing Address
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Address Line | 2435 FM 1406 RD.
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City | WINNIE
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State | TX
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Zip | 77665
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Country | US
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Telephone | 409-866-8886
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Fax |
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTIST
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Name | DR. LEE ANN MCQUADE
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Credential | DDS
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Telephone | 409-866-8886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 20249
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License Number State | TX
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