Provider Demographics
NPI:1407845118
Name:BEASLEY, JOHN MORGAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MORGAN
Last Name:BEASLEY
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 1:1620 BUSINESS AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-2398
Mailing Address - Country:US
Mailing Address - Phone:931-762-1975
Mailing Address - Fax:931-762-1975
Practice Address - Street 1:1620 BUSINESS AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2398
Practice Address - Country:US
Practice Address - Phone:931-762-1975
Practice Address - Fax:931-762-1975
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS40421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice