Individual
JUSTIN BEAGLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
421 WALNUT ST., LA JARA, CO 81140
(719) 274-8948
Mailing address
421 WALNUT ST., LA JARA, CO 81140
(719) 274-8948
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2024422
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2024422
LICENSURE
CO
Enumeration date
02/26/2021
Last updated
02/26/2021
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