Provider Demographics
NPI:1598829764
Name:BEASLEY, JULIE SUZANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:SUZANNE
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11671 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4139
Mailing Address - Country:US
Mailing Address - Phone:512-249-7668
Mailing Address - Fax:512-219-1246
Practice Address - Street 1:11671 JOLLYVILLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4139
Practice Address - Country:US
Practice Address - Phone:512-249-7668
Practice Address - Fax:512-219-1246
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224781223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics