Provider Demographics
NPI:1245293190
Name:BEESON, THOMAS JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:BEESON
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 1:3833 S 186TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130
Mailing Address - Country:US
Mailing Address - Phone:402-614-0240
Mailing Address - Fax:
Practice Address - Street 1:CREIGHTON UNIVERSITY DENTAL ENDODONTICS
Practice Address - Street 2:2500 CALIFORNIA PLAZA
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68178-0002
Practice Address - Country:US
Practice Address - Phone:402-280-5089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE51781223E0200X
CO1056911223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics