Provider Demographics
NPI:1316085749
Name:BEAMER, BONNIE MAE (DDS)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:MAE
Last Name:BEAMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 19TH ST NW
Mailing Address - Street 2:#310
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-6601
Mailing Address - Country:US
Mailing Address - Phone:202-331-1746
Mailing Address - Fax:202-466-8194
Practice Address - Street 1:1140 19TH ST NW
Practice Address - Street 2:#310
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-6601
Practice Address - Country:US
Practice Address - Phone:202-331-1746
Practice Address - Fax:202-466-8194
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN36231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics