Provider Demographics
NPI:1548397029
Name:BEENE, DANIEL TILMON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:TILMON
Last Name:BEENE
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:PO BOX 1133
Mailing Address - Street 2:615 N. JACKSON ST.
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71754-1133
Mailing Address - Country:US
Mailing Address - Phone:870-234-1110
Mailing Address - Fax:870-234-1112
Practice Address - Street 1:615 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2462
Practice Address - Country:US
Practice Address - Phone:870-234-1110
Practice Address - Fax:870-234-1112
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice