Beau McKenzie Soares, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

56076 Issued in CA

Practice address

500 S Anaheim Hills Rd
Suite #222
Anaheim Hills, CA 92807-4780

Phone

(714) 974-5906

Fax

(714) 974-5982

NPI assigned

Nov 27, 2007

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Mar 10, 2022 through Mar 10, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Beau McKenzie Soares D.D.S., Inc

  • Oral and Maxillofacial Surgery Clinic/Center
  • Anaheim, CA
  • NPI 1265710826
  Authorized official Same address or phone

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

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1205018629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S ANAHEIM HILLS RD",
            "address_2": "SUITE #222",
            "city": "ANAHEIM HILLS",
            "state": "CA",
            "postal_code": "928074780",
            "telephone_number": "714-974-5906",
            "fax_number": "714-974-5982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S ANAHEIM HILLS RD",
            "address_2": "SUITE #222",
            "city": "ANAHEIM HILLS",
            "state": "CA",
            "postal_code": "928074780",
            "telephone_number": "714-974-5906",
            "fax_number": "714-974-5982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOARES",
        "first_name": "BEAU",
        "middle_name": "MCKENZIE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-27",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "56076",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "56076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "56076",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebeca Martinez-Higareda, SLPA
• Ivan P Martinez, M.D.
• Maruko Orthodontics Inc
• Suzanne Renee Molera, B.A COMM. DISORDERS
• Taryl Lynn Nothern, NP
• Kevin Strachan, DDS
• Donovan Garcia Teves
• Michelle Elizabeth Washington, RNP
• Lila Zarei, MA, BCBA

• Oral and Maxillofacial Surgery (Dentist) in Anaheim Hills, CA
• Providers in Anaheim Hills, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.