Provider Demographics
NPI:1417263161
Name:BEELER, JEFFERY PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:PAUL
Last Name:BEELER
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 1:410 MOSER LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-4043
Mailing Address - Country:US
Mailing Address - Phone:901-262-4965
Mailing Address - Fax:
Practice Address - Street 1:875 HIGHWAY 321 N
Practice Address - Street 2:SUITE 200
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-7397
Practice Address - Country:US
Practice Address - Phone:865-816-6327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist