Provider Demographics
NPI:1053587717
Name:DEBORAH L. BEATY D.D.S., P.C.
Entity type:Organization
Organization Name:DEBORAH L. BEATY D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-332-4424
Mailing Address - Street 1:111 N WABASH AVE
Mailing Address - Street 2:SUITE 1921
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602
Mailing Address - Country:US
Mailing Address - Phone:312-332-4424
Mailing Address - Fax:312-332-4423
Practice Address - Street 1:111 N WABASH AVE STE 1921
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2970
Practice Address - Country:US
Practice Address - Phone:312-332-4424
Practice Address - Fax:312-332-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0600060221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL060006022OtherPROFESSIONAL CORPORATION/DENTAL