Provider Demographics
NPI:1235974742
Name:BEATTIE, MARY MARGARET (DDS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:BEATTIE
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11674 LITTLE PATUXENT PKWY APT 104
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4333
Mailing Address - Country:US
Mailing Address - Phone:614-506-8975
Mailing Address - Fax:
Practice Address - Street 1:284 MERRIMAC CT
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4133
Practice Address - Country:US
Practice Address - Phone:410-449-7056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD181621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice