Provider Demographics
NPI:1891768131
Name:BEITLER, SHEBA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHEBA
Middle Name:
Last Name:BEITLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PENNINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3406
Mailing Address - Country:US
Mailing Address - Phone:973-458-8053
Mailing Address - Fax:973-458-0182
Practice Address - Street 1:234 HEWES ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8141
Practice Address - Country:US
Practice Address - Phone:718-782-9425
Practice Address - Fax:718-782-9425
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0443261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02364414Medicaid