MEDICARE: DR. PATRICK DANIEL BEETAR D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	25731	TX

General Provider Information

NPI Number	:	1568777969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK DANIEL BEETAR D.D.S.

Provider Business Mailing Address
First Line	:	107 YALE ST
Second Line	:	SUITE 300
City	:	HOUSTON
State	:	TX
Zip	:	77007-3753
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 YALE ST
Second Line	:	SUITE 300
City	:	HOUSTON
State	:	TX
Zip	:	77007-3753
Country	:	US
Telephone Number	:	823-462-7633
Fax Number	:

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

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	07/31/2016

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Directions to “ DR. PATRICK DANIEL BEETAR D.D.S.” Practice Location

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