Provider Demographics
NPI:1093836645
Name:BEAGLE, JEFFREY BRENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRENT
Last Name:BEAGLE
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 1:826 ALTOS OAKS DR # 2
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5403
Mailing Address - Country:US
Mailing Address - Phone:650-948-8400
Mailing Address - Fax:650-948-4827
Practice Address - Street 1:826 ALTOS OAKS DR # 2
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5403
Practice Address - Country:US
Practice Address - Phone:650-948-8400
Practice Address - Fax:650-948-4827
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice