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General NPI Number Information
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NPI Number | 1619023280
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Entity Type | Individual
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Provider Name | JAY P BEARD DMD
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 401 HOFFMAN DR STE C
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City | HENDERSON
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State | KY
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Zip | 42420-3390
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Country | US
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Telephone | 270-827-1263
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 277
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City | HENDERSON
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State | KY
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Zip | 42419-0277
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Country | US
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Telephone | 270-827-1263
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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 | 4987
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License Number State | KY
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