Provider Demographics
NPI:1588261358
Name:MCBEATH, I'ESHA (EDDA)
Entity type:Individual
Prefix:
First Name:I'ESHA
Middle Name:
Last Name:MCBEATH
Suffix:
Gender:F
Credentials:EDDA
Other - Prefix:
Other - First Name:I'ESHA
Other - Middle Name:T
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2680 E MAIN ST # 335
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-2825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2680 E MAIN ST # 335
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2825
Practice Address - Country:US
Practice Address - Phone:317-332-7909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INXT014466126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant