Provider Demographics
NPI:1508166695
Name:BEIRL, BRIAN R (D D S)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:BEIRL
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7603 SEMINOLE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4888
Mailing Address - Country:US
Mailing Address - Phone:727-391-0269
Mailing Address - Fax:727-398-4992
Practice Address - Street 1:7603 SEMINOLE BLVD STE B
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4888
Practice Address - Country:US
Practice Address - Phone:727-391-0269
Practice Address - Fax:727-398-4992
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-24
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-3484972OtherDENTIST