Provider Demographics
NPI:1013331834
Name:BEISEL, JEREMIAH (DDS)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:BEISEL
Suffix:
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 1:15720 VENTURA BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2983
Mailing Address - Country:US
Mailing Address - Phone:818-788-7181
Mailing Address - Fax:818-907-1891
Practice Address - Street 1:15720 VENTURA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2983
Practice Address - Country:US
Practice Address - Phone:818-788-7181
Practice Address - Fax:818-907-1891
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice