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General NPI Number Information
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NPI Number | 1649463977
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Entity Type | Individual
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Provider Name | KENNETH C BEAL JR. D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 913 B.B. KING ROAD
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City | INDIANOLA
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State | MS
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Zip | 38751
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Country | US
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Telephone | 662-887-4814
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Fax | 662-887-9418
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Provider Business Mailing Address
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Address Line | PO BOX 1077
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City | INDIANOLA
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State | MS
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Zip | 38751-1077
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Country | US
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Telephone | 662-887-4814
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Fax | 662-887-9418
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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 | 2459-89
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License Number State | MS
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