Individual
DR. WILLIE KEITH BEASLEY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6211 CENTREVILLE RD, STE 600, CENTREVILLE, VA 20121-2635
(703) 961-8808
Mailing address
205 WEST ST NW, VIENNA, VA 22180-4416
(703) 255-0054
(703) 255-0779
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7175
VA
Other
Enumeration date
06/16/2005
Last updated
07/08/2007
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