Provider Demographics
NPI:1093242927
Name:BEARD, DAVID LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:BEARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 PARK AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1736
Mailing Address - Country:US
Mailing Address - Phone:614-940-9772
Mailing Address - Fax:
Practice Address - Street 1:4536 KARL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-1122
Practice Address - Country:US
Practice Address - Phone:614-447-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300254511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice