Provider Demographics
NPI:1750498325
Name:BEATY, DEGWANDA LONNETTE (DDS)
Entity Type:Individual
Prefix:
First Name:DEGWANDA
Middle Name:LONNETTE
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 1:5727 6TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011
Mailing Address - Country:US
Mailing Address - Phone:202-529-7955
Mailing Address - Fax:202-529-7955
Practice Address - Street 1:5727 6TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6201
Practice Address - Country:US
Practice Address - Phone:202-529-7955
Practice Address - Fax:202-529-7955
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN3766122300000X
MD7828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist