Provider Demographics
NPI:1184836702
Name:BEUMER, JOHN E III (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:BEUMER
Suffix:III
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84582
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073-0582
Mailing Address - Country:US
Mailing Address - Phone:310-825-6510
Mailing Address - Fax:310-206-4201
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-825-6510
Practice Address - Fax:310-206-4201
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD195851223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91297-01Medicaid
CAD19585Medicare PIN