Provider Demographics
NPI:1235481359
Name:BEADLESTON, DAVID LANCE (DVM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LANCE
Last Name:BEADLESTON
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 MARATHON RD
Mailing Address - Street 2:
Mailing Address - City:NIWOT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-8663
Mailing Address - Country:US
Mailing Address - Phone:303-682-2437
Mailing Address - Fax:303-485-6105
Practice Address - Street 1:8930 MARATHON RD
Practice Address - Street 2:
Practice Address - City:NIWOT
Practice Address - State:CO
Practice Address - Zip Code:80503-8663
Practice Address - Country:US
Practice Address - Phone:303-682-2437
Practice Address - Fax:303-485-6105
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4375174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian