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General NPI Number Information
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NPI Number | 1700323730
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Entity Type | Individual
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Provider Name | KELSEY BEAMAN
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Gender | Female
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Dates
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Enumeration Date | 01/29/2017
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Last Update Date | 01/29/2017
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Provider Practice Location Address
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Address Line | 1606 GOLDEN ASPEN DR #110
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City | AMES
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State | IA
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Zip | 50010-8011
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Country | US
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Telephone | 515-232-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 203 W 9TH ST
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City | BOONE
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State | IA
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Zip | 50036-1919
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Country | US
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Telephone | 515-391-9756
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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 | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | QDA-10780
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License Number State | IA
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