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General NPI Number Information
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NPI Number | 1700946647
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Entity Type | Individual
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Provider Name | BEVERLY A LARGENT D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 3008 OREGON ST
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City | PADUCAH
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State | KY
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Zip | 42001-5651
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Country | US
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Telephone | 270-554-5437
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Fax | 270-554-5236
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Provider Business Mailing Address
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Address Line | 3008 OREGON ST
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City | PADUCAH
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State | KY
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Zip | 42001-5651
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Country | US
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Telephone | 270-554-5437
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Fax | 270-554-5236
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 5466
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License Number State | KY
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