Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 19296 | MT |
NPI | 1154617389 |
---|---|
Provider Name | Dr. Jeffrey T Beacham |
First Address | Billings, MT 59102-4707 |
Second Address | Billings, MT 59102-4707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2011 |
Last Update Date | 27/05/2020 |