Provider Demographics
NPI:1235199324
Name:BEYERLE, MARCUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:
Last Name:BEYERLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 VINCENT ST.
Mailing Address - Street 2:ATTN: 21 DENTAL SQUADRON/SGD - DENTAL
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1540
Mailing Address - Country:US
Mailing Address - Phone:719-556-1338
Mailing Address - Fax:866-867-7926
Practice Address - Street 1:559 VINCENT ST.
Practice Address - Street 2:ATTN: 21 DENTAL SQUADRON/SGD - DENTAL
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914-1540
Practice Address - Country:US
Practice Address - Phone:719-556-1338
Practice Address - Fax:866-867-7926
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY54341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice