Provider Demographics
NPI:1144425893
Name:BEACHLEY, EDWARD R (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:BEACHLEY
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 1:11906 INDIAN LN
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-4204
Mailing Address - Country:US
Mailing Address - Phone:301-733-2217
Mailing Address - Fax:301-393-9289
Practice Address - Street 1:22109 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:SMITHSBURG
Practice Address - State:MD
Practice Address - Zip Code:21783-2059
Practice Address - Country:US
Practice Address - Phone:301-824-5111
Practice Address - Fax:301-714-0150
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD081721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice