Healthcare Provider Details

I. General information

NPI: 1972626513
Provider Name (Legal Business Name): KIMBERLY BEARD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2362 W BOULEVARD SUITE A
KOKOMO IN
46902-6080
US

IV. Provider business mailing address

2362 W BOULEVARD SUITE A
KOKOMO IN
46902-6080
US

V. Phone/Fax

Practice location:
  • Phone: 765-452-0530
  • Fax: 765-452-0573
Mailing address:
  • Phone: 765-452-0530
  • Fax: 765-452-0573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12010043A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: