Provider Demographics
NPI:1902038797
Name:BEAUCHAMP, THOMAS WILLIAM SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:BEAUCHAMP
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MILL ST. PO BOX 313
Mailing Address - Street 2:THOMAS W. BEAUCHAMP DDS
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349
Mailing Address - Country:US
Mailing Address - Phone:864-472-8717
Mailing Address - Fax:864-472-6100
Practice Address - Street 1:26 MILL ST.
Practice Address - Street 2:THOMAS W. BEAUCHAMP DDS
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349
Practice Address - Country:US
Practice Address - Phone:864-472-8717
Practice Address - Fax:864-472-6100
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice