Healthcare Provider Details

I. General information

NPI: 1588015044
Provider Name (Legal Business Name): 23 BEADLE DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16005 US ROUTE 23
CATLETTSBURG KY
41129-9070
US

IV. Provider business mailing address

16005 US ROUTE 23
CATLETTSBURG KY
41129-9070
US

V. Phone/Fax

Practice location:
  • Phone: 606-739-0403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. RALPH BEADLE
Title or Position: OWNER
Credential:
Phone: 606-739-0403