MEDICARE: BEATA REGINA DEVIRION DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019022981	IL

General Provider Information

NPI Number	:	1154493187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATA REGINA DEVIRION DDS

Provider Business Mailing Address
First Line	:	250 W KENSINGTON RD
Second Line	:	SUITE 3A
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-1293
Country	:	US
Telephone Number	:	847-253-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 W KENSINGTON RD
Second Line	:	SUITE 3A
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-1293
Country	:	US
Telephone Number	:	847-253-7070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	11/01/2012

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