Provider Demographics
NPI:1225288129
Name:BEAL, CHRIS C (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:C
Last Name:BEAL
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:PO BOX 5499
Mailing Address - Street 2:1185 CAPITOL ST. SUITE 104
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-5499
Mailing Address - Country:US
Mailing Address - Phone:970-328-5268
Mailing Address - Fax:970-328-5267
Practice Address - Street 1:1185 CAPITOL ST STE 104
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631-5000
Practice Address - Country:US
Practice Address - Phone:970-328-5268
Practice Address - Fax:970-328-5267
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9677122300000X
CA54859122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1972871051OtherFACILITY NPI