Provider Demographics
NPI:1891830246
Name:DORIAN, BETH ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
Last Name:DORIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:340 JUSTIN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLATTEVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80651-7818
Mailing Address - Country:US
Mailing Address - Phone:970-353-2330
Mailing Address - Fax:970-797-6403
Practice Address - Street 1:340 JUSTIN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PLATTEVILLE
Practice Address - State:CO
Practice Address - Zip Code:80651-7818
Practice Address - Country:US
Practice Address - Phone:970-785-6280
Practice Address - Fax:970-797-6403
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10088122300000X, 1223G0001X
GADN012540122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36876321Medicaid