Provider Demographics
NPI:1235242421
Name:BEENE GREGORY, EMMALEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMMALEE
Middle Name:
Last Name:BEENE GREGORY
Suffix:
Gender:F
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 432
Mailing Address - Street 2:1018 N WASHINGTON ST
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71754-0432
Mailing Address - Country:US
Mailing Address - Phone:870-234-5244
Mailing Address - Fax:870-234-7504
Practice Address - Street 1:1018 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71754-0432
Practice Address - Country:US
Practice Address - Phone:870-234-5244
Practice Address - Fax:870-234-7504
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR29901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice