MEDICARE: HANNAH RYAN BEATTY DMD

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	0401413808	VA

General Provider Information

NPI Number	:	1881948552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH RYAN BEATTY DMD

Provider Business Mailing Address
First Line	:	8353A GREENSBORO DR
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3530
Country	:	US
Telephone Number	:	703-442-0442
Fax Number	:	703-442-0498

Provider Business Practice Location Address
First Line	:	8353A GREENSBORO DR
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3530
Country	:	US
Telephone Number	:	703-442-0442
Fax Number	:	703-442-0498

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

Provider Enumeration Date	:	11/02/2012
Last Update Date	:	11/02/2012

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