Provider Demographics
NPI:1831712785
Name:JEFFREY T BEACHAM DMD PLLC
Entity type:Organization
Organization Name:JEFFREY T BEACHAM DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEACHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-656-8300
Mailing Address - Street 1:2225 BROADWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4707
Mailing Address - Country:US
Mailing Address - Phone:406-656-8300
Mailing Address - Fax:406-656-9088
Practice Address - Street 1:2225 BROADWATER AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4707
Practice Address - Country:US
Practice Address - Phone:406-656-8300
Practice Address - Fax:406-656-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty