Provider Demographics
NPI:1588736193
Name:BEERS, DUANE H (DMD, FAGD, AAACD)
Entity type:Individual
Prefix:DR
First Name:DUANE
Middle Name:H
Last Name:BEERS
Suffix:
Gender:M
Credentials:DMD, FAGD, AAACD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MANZANARES AVE E
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-4215
Mailing Address - Country:US
Mailing Address - Phone:505-835-3662
Mailing Address - Fax:505-838-1631
Practice Address - Street 1:200 MANZANARES AVE E
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4215
Practice Address - Country:US
Practice Address - Phone:505-835-3662
Practice Address - Fax:505-838-1631
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM12901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1290OtherDENTAL LICENSE
46180OtherUNITED CONCORDIA PROVIDER
008063OtherBCBS PROVIDER #
850280827OtherTIN