Provider Demographics
NPI:1124896220
Name:TED BEAUCHAMP, DDS LLC
Entity type:Organization
Organization Name:TED BEAUCHAMP, DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BEAUCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-487-0122
Mailing Address - Street 1:853 MEDICAL DR STE 112
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3825
Mailing Address - Country:US
Mailing Address - Phone:636-487-0122
Mailing Address - Fax:
Practice Address - Street 1:853 MEDICAL DR STE 112
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3825
Practice Address - Country:US
Practice Address - Phone:636-487-0122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty