Provider Demographics
NPI:1447611629
Name:BEAUCHAMP, MARIELLE YOUMANS (DMD)
Entity Type:Individual
Prefix:
First Name:MARIELLE
Middle Name:YOUMANS
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 FALLS DR APT 1213
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-3540
Mailing Address - Country:US
Mailing Address - Phone:229-254-2098
Mailing Address - Fax:
Practice Address - Street 1:5310 FALLS DR APT 1213
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-3540
Practice Address - Country:US
Practice Address - Phone:229-254-2098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0152941223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics