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General NPI Number Information
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NPI Number | 1568615292
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Entity Type | Individual
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Provider Name | JENNIFER LYNN BEAVIN D.M.D
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Gender | Female
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Dates
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Enumeration Date | 10/26/2008
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 1976 DOUGLASS BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40205-1826
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Country | US
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Telephone | 502-454-7627
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Fax | 502-384-8203
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Provider Business Mailing Address
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Address Line | 814 FETTER AVE
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City | LOUISVILLE
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State | KY
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Zip | 40217-2233
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Country | US
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Telephone | 502-724-0397
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS0000008818
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8632
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12011286A
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License Number State | IN
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