Provider Demographics
NPI:1215009337
Name:BEAN, KARL SHERIDAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:SHERIDAN
Last Name:BEAN
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 1:54 N COUNTRY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1409
Mailing Address - Country:US
Mailing Address - Phone:631-928-6566
Mailing Address - Fax:
Practice Address - Street 1:54 N COUNTRY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-1409
Practice Address - Country:US
Practice Address - Phone:631-928-6566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027396208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00621590Medicaid