Provider Demographics
NPI:1689846495
Name:BEATY, DEBORAH LORENE (DDS)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LORENE
Last Name:BEATY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N. WABASH AVE. SUITE 1921
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602
Mailing Address - Country:US
Mailing Address - Phone:312-332-4424
Mailing Address - Fax:312-332-4423
Practice Address - Street 1:111 N WABASH AVE STE 1921
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2970
Practice Address - Country:US
Practice Address - Phone:312-332-4424
Practice Address - Fax:312-332-4423
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist