Provider Demographics
NPI:1891075404
Name:BEAUCHAMP, REBECCA (DDS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:BEAUCHAMP
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 1:1188 N SALEM RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-8807
Mailing Address - Country:US
Mailing Address - Phone:479-527-0707
Mailing Address - Fax:
Practice Address - Street 1:1188 N SALEM RD
Practice Address - Street 2:SUITE 10
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-8807
Practice Address - Country:US
Practice Address - Phone:479-527-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR38271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice