Individual
DR. BEAU UPSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
3238 KRISAM CREEK DR, LOGANVILLE, GA 30052-7942
(770) 466-0474
Mailing address
3238 KRISAM CREEK DR, LOGANVILLE, GA 30052-7942
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN014781
GA
Other
Enumeration date
06/03/2014
Last updated
10/28/2014
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