Provider Demographics
NPI:1689745200
Name:BEATTIE, MARSHA L (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:L
Last Name:BEATTIE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:44589 FENWICK DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3243
Mailing Address - Country:US
Mailing Address - Phone:734-398-5615
Mailing Address - Fax:
Practice Address - Street 1:21213 ECORSE RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1834
Practice Address - Country:US
Practice Address - Phone:313-292-7777
Practice Address - Fax:313-292-7515
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010184341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics