Provider Demographics
NPI:1003943812
Name:BEATTY, DOROTHY LUCILLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:LUCILLE
Last Name:BEATTY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 AZUL LOOP
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8242
Mailing Address - Country:US
Mailing Address - Phone:505-466-1603
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE MEDICO STE 4
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4785
Practice Address - Country:US
Practice Address - Phone:505-984-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM13931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice