Provider Demographics
NPI:1528073103
Name:BEALS, DOUGLAS WILLIAM (DDS MS)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:WILLIAM
Last Name:BEALS
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:W
Other - Last Name:BEALS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS MS PC
Mailing Address - Street 1:8575 E PRINCESS DR
Mailing Address - Street 2:SUITE 217
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255
Mailing Address - Country:US
Mailing Address - Phone:480-342-8200
Mailing Address - Fax:480-342-8008
Practice Address - Street 1:8575 E PRINCESS DR
Practice Address - Street 2:SUITE 217
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255
Practice Address - Country:US
Practice Address - Phone:480-342-8200
Practice Address - Fax:480-342-8008
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist