Provider Demographics
NPI:1972721033
Name:JOHN, BEENA GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEENA
Middle Name:GEORGE
Last Name:JOHN
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 1:145 OYSTER CREEK DR
Mailing Address - Street 2:STE., 8A
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4197
Mailing Address - Country:US
Mailing Address - Phone:979-297-3882
Mailing Address - Fax:979-297-4497
Practice Address - Street 1:145 OYSTER CREEK DR
Practice Address - Street 2:STE., 8A
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4197
Practice Address - Country:US
Practice Address - Phone:979-297-3882
Practice Address - Fax:979-297-4497
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice