Individual
DR. BEAU MCKENZIE SOARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
500 S ANAHEIM HILLS RD, SUITE #222, ANAHEIM HILLS, CA 92807-4780
(714) 974-5906
(714) 974-5982
Mailing address
500 S ANAHEIM HILLS RD, SUITE #222, ANAHEIM HILLS, CA 92807-4780
(714) 974-5906
(714) 974-5982
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
56076
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
56076
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56076
DENTAL LICENSE
CA
Enumeration date
11/27/2007
Last updated
03/07/2023
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