Individual
DUDLEY C. BEATY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
225 BROAD ST, BENNETTSVILLE, SC 29512-4003
(843) 479-0305
Mailing address
225 BROAD ST, BENNETTSVILLE, SC 29512-4003
(843) 479-0305
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2906
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2906
DELTA DENTAL PROVIDER #
SC
05
—
Z29062
—
SC
Enumeration date
01/05/2006
Last updated
07/09/2007
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