Provider Demographics
NPI:1881612240
Name:JOHN C BEATY DDS, FAMILY DENTISTRY
Entity type:Organization
Organization Name:JOHN C BEATY DDS, FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:321-452-8334
Mailing Address - Street 1:113 N BANANA RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-2546
Mailing Address - Country:US
Mailing Address - Phone:321-452-8334
Mailing Address - Fax:321-452-8335
Practice Address - Street 1:113 N BANANA RIVER DR
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-2546
Practice Address - Country:US
Practice Address - Phone:321-452-8334
Practice Address - Fax:321-452-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty