Provider Demographics
NPI:1003160599
Name:KENNETH E. BEARD, DDS,PC
Entity Type:Organization
Organization Name:KENNETH E. BEARD, DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-476-6541
Mailing Address - Street 1:415 25TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3892
Mailing Address - Country:US
Mailing Address - Phone:423-476-6541
Mailing Address - Fax:423-472-7719
Practice Address - Street 1:415 25TH ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3892
Practice Address - Country:US
Practice Address - Phone:423-476-6541
Practice Address - Fax:423-472-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2223122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty