Provider Demographics
NPI:1417120122
Name:VERNON BEAMON,DMD
Entity Type:Organization
Organization Name:VERNON BEAMON,DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:F
Authorized Official - Last Name:BEAMON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:228-896-3600
Mailing Address - Street 1:400 COURTHOUSE PLZ
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3231
Mailing Address - Country:US
Mailing Address - Phone:228-896-3600
Mailing Address - Fax:
Practice Address - Street 1:400 COURTHOUSE PLZ
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3231
Practice Address - Country:US
Practice Address - Phone:228-896-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS30471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty