Provider Demographics
NPI:1215017983
Name:BEALS, ROBERT PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:BEALS
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 1:606 SPRING ST
Mailing Address - Street 2:P.O. BOX 6216
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2028
Mailing Address - Country:US
Mailing Address - Phone:478-746-4578
Mailing Address - Fax:478-745-6413
Practice Address - Street 1:606 SPRING ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2028
Practice Address - Country:US
Practice Address - Phone:478-746-4578
Practice Address - Fax:478-745-6413
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA70141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice