Provider Demographics
NPI:1457906869
Name:JEREMIAH BEISEL DDS, INC.
Entity type:Organization
Organization Name:JEREMIAH BEISEL DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-788-7181
Mailing Address - Street 1:15720 VENTURA BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2983
Mailing Address - Country:US
Mailing Address - Phone:818-788-7181
Mailing Address - Fax:
Practice Address - Street 1:15720 VENTURA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2983
Practice Address - Country:US
Practice Address - Phone:818-788-7181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-03
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental