Provider Demographics
NPI:1558709378
Name:BEAN, DESTINY (DDS)
Entity type:Individual
Prefix:DR
First Name:DESTINY
Middle Name:
Last Name:BEAN
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 1:15889 PRESTON RD APT 1130
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-3811
Mailing Address - Country:US
Mailing Address - Phone:210-347-1323
Mailing Address - Fax:
Practice Address - Street 1:15889 PRESTON RD APT 1130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-3811
Practice Address - Country:US
Practice Address - Phone:210-347-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28905122300000X
NY058426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist