Basic Information
| Provider Information | |||||||||
| NPI: | 1528126018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEAL | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2295 WORTHINGTON DR | ||||||||
| Address2: | |||||||||
| City: | POWDER SPRINGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301273394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782960772 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4458 JONESBORO RD | ||||||||
| Address2: | |||||||||
| City: | FOREST PARK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302974314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789045665 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DN011823 | GA | Y | Dental Providers | Dentist | General Practice |
No ID Information.