Provider Demographics
NPI:1033237318
Name:DR DARRYLL L BEARD DMD LTD
Entity Type:Organization
Organization Name:DR DARRYLL L BEARD DMD LTD
Other - Org Name:DRS BEARD & HOLMEN LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYLL
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-939-7181
Mailing Address - Street 1:208 BRADFORD LANE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298
Mailing Address - Country:US
Mailing Address - Phone:618-939-7181
Mailing Address - Fax:618-939-4500
Practice Address - Street 1:208 BRADFORD LANE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298
Practice Address - Country:US
Practice Address - Phone:618-939-7181
Practice Address - Fax:618-939-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty