Provider Demographics
NPI:1417999152
Name:BEITEL, BRIAN A (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
Last Name:BEITEL
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:580 AIRPORT RD SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1309
Mailing Address - Country:US
Mailing Address - Phone:256-883-6023
Mailing Address - Fax:256-883-3557
Practice Address - Street 1:580 AIRPORT RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1309
Practice Address - Country:US
Practice Address - Phone:256-883-6023
Practice Address - Fax:256-883-3557
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL40581223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry