Provider Demographics
NPI:1851508188
Name:BEASON, BRANDY (RDH)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:BEASON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 PINEHILL ROAD
Mailing Address - Street 2:
Mailing Address - City:ST. MATTHEWS
Mailing Address - State:SC
Mailing Address - Zip Code:29135
Mailing Address - Country:US
Mailing Address - Phone:803-682-0416
Mailing Address - Fax:803-808-5642
Practice Address - Street 1:100 OLD CHEROKEE ROAD
Practice Address - Street 2:SUITE F, BOX 14
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072
Practice Address - Country:US
Practice Address - Phone:803-808-2950
Practice Address - Fax:803-808-5642
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3540124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist