Provider Demographics
NPI:1528126018
Name:BEAL, DEBORAH ANN (DDS)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:BEAL
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 1:2295 WORTHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-3394
Mailing Address - Country:US
Mailing Address - Phone:678-296-0772
Mailing Address - Fax:
Practice Address - Street 1:4458 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-4314
Practice Address - Country:US
Practice Address - Phone:678-904-5665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0118231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice