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General NPI Number Information
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NPI Number | 1194045617
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Entity Type | Organization
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Legal Business Name | CLARKSVILLE PEDIATRIC DENTISTRY, PC
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 06/08/2010
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Provider Practice Location Address
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Address Line | 2297 RUDOLPHTOWN RD
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City | CLARKSVILLE
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State | TN
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Zip | 37043-2226
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Country | US
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Telephone | 931-245-3333
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Fax | 931-245-3334
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Provider Business Mailing Address
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Address Line | 2297 RUDOLPHTOWN RD
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City | CLARKSVILLE
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State | TN
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Zip | 37043-2226
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Country | US
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Telephone | 931-245-3333
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Fax | 931-245-3334
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KARYL JEAN BEAUCHAMP
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Credential | DDS
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Telephone | 931-245-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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