Provider Demographics
NPI:1811370588
Name:BEUS, JACOB (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:BEUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3732
Mailing Address - Country:US
Mailing Address - Phone:719-275-3255
Mailing Address - Fax:719-275-3863
Practice Address - Street 1:330 MAIN ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3732
Practice Address - Country:US
Practice Address - Phone:719-275-3255
Practice Address - Fax:719-275-3863
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6184711-99221223G0001X
CODEN.002027581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice