Individual
BEAUREGARD STORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
104564
CA
1223D0004X
Dental Anesthesiology
Primary
104564
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2019
Last updated
07/01/2024
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