Provider Demographics
NPI:1649228743
Name:BEATTIE, MARC D (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:D
Last Name:BEATTIE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 N. ELM ST. #201
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455
Mailing Address - Country:US
Mailing Address - Phone:336-545-4281
Mailing Address - Fax:239-596-7996
Practice Address - Street 1:3810 N. ELM ST. #201
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455
Practice Address - Country:US
Practice Address - Phone:336-545-4281
Practice Address - Fax:239-596-7996
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN169181223G0001X
NC105701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice