Provider Demographics
NPI:1164197596
Name:XU, BEVERLEY
Entity Type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 MERCER ST APT 4
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3589
Mailing Address - Country:US
Mailing Address - Phone:347-263-4347
Mailing Address - Fax:
Practice Address - Street 1:43 MERCER ST APT 4
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3589
Practice Address - Country:US
Practice Address - Phone:347-263-4347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist