Provider Demographics
NPI:1023373362
Name:ULRICH, BEAU (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEAU
Middle Name:
Last Name:ULRICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5121
Mailing Address - Country:US
Mailing Address - Phone:530-885-8331
Mailing Address - Fax:530-885-6036
Practice Address - Street 1:1112 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5121
Practice Address - Country:US
Practice Address - Phone:530-885-8331
Practice Address - Fax:530-885-6036
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA585971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics