Provider Demographics
NPI:1659565794
Name:BEALS, ROY M I (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:M
Last Name:BEALS
Suffix:I
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 1:12444 VICTORY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3199
Mailing Address - Country:US
Mailing Address - Phone:818-763-4367
Mailing Address - Fax:818-769-6943
Practice Address - Street 1:12444 VICTORY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3199
Practice Address - Country:US
Practice Address - Phone:818-763-4367
Practice Address - Fax:818-769-6943
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21849122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist