Provider Demographics
NPI:1467556175
Name:BEITLER, CLAUDE T (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:T
Last Name:BEITLER
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 1:646 N SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-1028
Mailing Address - Country:US
Mailing Address - Phone:419-294-2125
Mailing Address - Fax:419-294-2866
Practice Address - Street 1:646 N SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-1028
Practice Address - Country:US
Practice Address - Phone:419-294-2125
Practice Address - Fax:419-294-2866
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0478166Medicaid