1467591826 NPI number — DR. DOUGLAS OWEN BEISCHEL DDS

Table of content: DR. DOUGLAS OWEN BEISCHEL DDS (NPI 1467591826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467591826 NPI number — DR. DOUGLAS OWEN BEISCHEL DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEISCHEL
Provider First Name:
DOUGLAS
Provider Middle Name:
OWEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467591826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7125 E LINCOLN DR
Provider Second Line Business Mailing Address:
SUITE B108
Provider Business Mailing Address City Name:
PARADISE VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85253-4429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-948-1450
Provider Business Mailing Address Fax Number:
480-922-8601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7125 E LINCOLN DR
Provider Second Line Business Practice Location Address:
SUITE B108
Provider Business Practice Location Address City Name:
PARADISE VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85253-4429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-948-1450
Provider Business Practice Location Address Fax Number:
480-922-8601
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D4398 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 826546 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".




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