Dudley C. Beaty III, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2906 Issued in SC

Practice address

225 Broad St
Bennettsville, SC 29512-4003

Phone

(843) 479-0305

NPI assigned

Jan 5, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dudley C. Beaty III, DMD, PC

  • General Practice Dentistry
  • Bennettsville, SC
  • NPI 1376693937
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1003894478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 BROAD ST",
            "city": "BENNETTSVILLE",
            "state": "SC",
            "postal_code": "295124003",
            "telephone_number": "843-479-0305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 BROAD ST",
            "city": "BENNETTSVILLE",
            "state": "SC",
            "postal_code": "295124003",
            "telephone_number": "843-479-0305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEATY",
        "first_name": "DUDLEY",
        "middle_name": "C.",
        "name_suffix": "III",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "2906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z29062",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL PROVIDER #",
            "identifier": "2906",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Atlee Counseling, LLC
• Christian L. Barnes-Young, MS, LPC
• Katie Grace Bateman, MA
• Carolyn Bazen, M.S.
• Beaty Eye Clinic & Associates, Inc.
• Elizabeth James Beaty, O.D.
• Eunice Carnelia Bell, MSW
• Bennettsville Health and Rehab LLC (Bennettsville Health and Rehab)
• Bennettsville Health Care LLC (Bennettsville Health and Rehabilitation Center)
• Elin B. Berg, M.D.

• General Practice Dentistry in Bennettsville, SC
• Providers in Bennettsville, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.