Individual
DR. DOUGLAS L. BEAUDRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., P.S.
Contact information
Practice address
204 12TH AVE SW, EPHRATA, WA 98823-2197
(509) 754-3262
(509) 754-3262
Mailing address
204 12TH AVE SW, EPHRATA, WA 98823-2197
(509) 754-3262
(509) 754-3262
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00004598
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05431
WDS LICENSE #
WA
01
—
4598
STATE DENTAL LICENSE #
WA
05
—
5543103
—
WA
Enumeration date
12/05/2006
Last updated
07/09/2007
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