Provider Demographics
NPI:1881766244
Name:BEALL, TIMOTHY BRIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:BRIAN
Last Name:BEALL
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 1:426 BARCELLUS AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6927
Mailing Address - Country:US
Mailing Address - Phone:805-922-2191
Mailing Address - Fax:805-347-7850
Practice Address - Street 1:426 EAST BARCELLUS , SUITE 204
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-922-2191
Practice Address - Fax:805-347-7850
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA032023122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist