Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5350 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 397 | KY |
NPI | 1114981420 |
---|---|
Provider Name | Dr. Louis M. Beto |
First Address | Danville, KY 40422-2007 |
Second Address | Danville, KY 40422-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 22/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60053501 | (05) | KY |
64053507 | (05) | KY |
T83942 | (02) | KY |