Provider Demographics
NPI:1811986243
Name:BEATTIE, JEFFREY L (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:BEATTIE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 W FAIRBANKS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4679
Mailing Address - Country:US
Mailing Address - Phone:407-644-0224
Mailing Address - Fax:407-644-2827
Practice Address - Street 1:1573 W FAIRBANKS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4679
Practice Address - Country:US
Practice Address - Phone:407-644-0224
Practice Address - Fax:407-644-2827
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN115581223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL190007446OtherRAILROAD MCARE ORL OFC
FL224946OtherWELLCARE ORLANDO OFC
FL850000180OtherRAILROAD MCARE LW OFC
FLBCBS MEDICALOther69148
FL06818OtherWELLCARE WINTER PARK OFC
FL190007440OtherRAILROAD MCARE WP OFC
FL224944OtherWELLCARE LONGWOOD OFC
FL224944OtherWELLCARE LONGWOOD OFC
FL69148XMedicare ID - Type UnspecifiedORLANDO OFFICE
FL190007446OtherRAILROAD MCARE ORL OFC
FL190007440OtherRAILROAD MCARE WP OFC