# MICHAEL W BEASLEY DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144661273
- **Authorized official:** VICKI LEE BEASLEY (OPERATION MANAGER)
- **Authorized official phone:** (719) 216-2054

## Contact information

- **Practice address:** 6475 WALL ST STE 202, COLORADO SPRINGS, CO 80918-8341
- **Practice address phone:** (719) 216-2054
- **Mailing address:** 6475 WALL ST STE 202, COLORADO SPRINGS, CO 80918-8341
- **Mailing address phone:** (719) 216-2054

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 6670 | CO | Yes |

## Other

- **Enumeration date:** 07/17/2013
- **Last updated:** 07/17/2013