Provider Demographics
NPI:1922149475
Name:BEDDALL, HAROLD LEWIS
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:LEWIS
Last Name:BEDDALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7311 SW 62ND AVE
Mailing Address - Street 2:203
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-8804
Mailing Address - Country:US
Mailing Address - Phone:305-667-2633
Mailing Address - Fax:
Practice Address - Street 1:7311 SW 62ND AVE
Practice Address - Street 2:203
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-8804
Practice Address - Country:US
Practice Address - Phone:305-667-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist