Provider Demographics
NPI:1134164122
Name:BEALS, PATRICIA (DMD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BEALS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W THOMAS RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4405
Mailing Address - Country:US
Mailing Address - Phone:602-406-3560
Mailing Address - Fax:602-406-1011
Practice Address - Street 1:124 W THOMAS RD
Practice Address - Street 2:SUITE 330
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4405
Practice Address - Country:US
Practice Address - Phone:602-406-3560
Practice Address - Fax:602-406-1011
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD070441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050739Medicare ID - Type Unspecified
U86811Medicare UPIN