David N. Beauchamp, DDS
Individual provider Active NPI General Practice Dentistry · Bainbridge, GA
NPI 1023192556 · NPPES record last updated Sep 25, 2012
Key facts
- NPI
- 1023192556
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 9222 (GA)
- Practice address
- 709 E Shotwell St
Bainbridge, GA 39819-4063 - Phone
- (229) 246-3686
- Fax
- (229) 246-5011
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9222 | GA | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Port City Family Dental Associates | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9222 | GA | Yes |
Addresses
Primary practice location
709 E Shotwell St
Bainbridge, GA 39819-4063
Mailing address
709 E Shotwell St
Bainbridge, GA 39819-4063
Phone (229) 246-3686
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00205928A | Medicaid | GA |
Other providers in Bainbridge, GA
- Bainbridge Vision Clinic Inc
- Ladonna M Bass
- Matikka Baulkman
- Kimberly Baxley
- Chris Beam
- Andre Q Bell
- David Lee Breault
- Bridge Behavior Consulting LLC
- Bridge of Hope Counseling Services, LLC
- Benjamin Henry Taylor Bridges
All providers in Bainbridge, GA · General Practice Dentistry in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.