Provider Demographics
NPI:1477092781
Name:BEATUS DENTIUM, LLC
Entity Type:Organization
Organization Name:BEATUS DENTIUM, LLC
Other - Org Name:DENTEFFEX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORGANIZER/ SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALOIS
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:TRIPAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-229-1878
Mailing Address - Street 1:6638 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8891
Mailing Address - Country:US
Mailing Address - Phone:970-229-1878
Mailing Address - Fax:970-229-1878
Practice Address - Street 1:1802 SPRING CT
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7346
Practice Address - Country:US
Practice Address - Phone:307-635-3018
Practice Address - Fax:307-635-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1467261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental