Provider Demographics
NPI:1710062856
Name:BEALS, GREGORY (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:BEALS
Suffix:
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 1:3022 N 125TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-2598
Mailing Address - Country:US
Mailing Address - Phone:402-616-1530
Mailing Address - Fax:402-758-0030
Practice Address - Street 1:17775 MASON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-3559
Practice Address - Country:US
Practice Address - Phone:402-758-9399
Practice Address - Fax:402-758-0030
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE63801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice