Provider Demographics
NPI:1407955388
Name:BEASLEY, ROBERT BRAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRAD
Last Name:BEASLEY
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 1:200 E HOBBS ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2108
Mailing Address - Country:US
Mailing Address - Phone:256-233-1400
Mailing Address - Fax:256-233-1404
Practice Address - Street 1:200 E HOBBS ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2108
Practice Address - Country:US
Practice Address - Phone:256-233-1400
Practice Address - Fax:256-233-1404
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice