Provider Demographics
NPI:1053699165
Name:BEAINI, DANA LEE (DDS)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LEE
Last Name:BEAINI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BERNADETTE DR
Mailing Address - Street 2:SUITE 217
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4672
Mailing Address - Country:US
Mailing Address - Phone:573-445-9405
Mailing Address - Fax:573-445-9446
Practice Address - Street 1:2401 BERNADETTE DR
Practice Address - Street 2:SUITE 217
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4672
Practice Address - Country:US
Practice Address - Phone:573-445-9405
Practice Address - Fax:573-445-9446
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120153561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012015356OtherMISSOURI STATE DENTAL LICENSE
TX27209OtherLICENSE