MEDICARE: KELSEY NICOLE BEALMEAR DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30.027690	OH

General Provider Information

NPI Number	:	1629765912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY NICOLE BEALMEAR DDS

Provider Business Mailing Address
First Line	:	4430 N HOLLAND SYLVANIA RD APT 4321
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3557
Country	:	US
Telephone Number	:	240-439-9479
Fax Number	:

Provider Business Practice Location Address
First Line	:	4333 MONROE ST STE B
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1937
Country	:	US
Telephone Number	:	419-475-0482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	08/21/2024

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