Organization
DUDLEY C. BEATY III, DMD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DUDLEY C. BEATY III DMD (OWNER)
(843) 479-0305
Entity
Organization
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2906
DELTA DENTAL PROVIDER #
SC
05
—
ZA9903
—
SC
Enumeration date
01/12/2007
Last updated
08/22/2020
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