MEDICARE: DR. KRISTEN TOMLINSON BEABOUT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401412497	VA

General Provider Information

NPI Number	:	1013149350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN TOMLINSON BEABOUT DDS

Provider Business Mailing Address
First Line	:	1130 WILKINSON RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-1623
Country	:	US
Telephone Number	:	804-261-4020
Fax Number	:	804-261-6839

Provider Business Practice Location Address
First Line	:	1130 WILKINSON RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-1623
Country	:	US
Telephone Number	:	804-261-4020
Fax Number	:	804-261-6839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2009
Last Update Date	:	10/06/2010

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