Provider Demographics
NPI:1720182124
Name:BEATTY, CHAD LAURENT (DMD MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:LAURENT
Last Name:BEATTY
Suffix:
Gender:M
Credentials:DMD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8190 OAKLEAF LANE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-636-1530
Mailing Address - Fax:
Practice Address - Street 1:555 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-5358
Practice Address - Country:US
Practice Address - Phone:716-694-1134
Practice Address - Fax:716-694-0665
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0500221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000527196004OtherBC/BS COMMUNITY BLUE
NY00026001505OtherUNIVERA
NY02364661Medicaid
G31342Medicare UPIN
NY000527196004OtherBC/BS COMMUNITY BLUE