Provider Demographics
NPI:1376559393
Name:BEADLE, KEVIN W (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
Last Name:BEADLE
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 1:6196 STRATHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-4628
Mailing Address - Country:US
Mailing Address - Phone:317-709-2318
Mailing Address - Fax:
Practice Address - Street 1:6196 STRATHAVEN RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-4628
Practice Address - Country:US
Practice Address - Phone:317-709-2318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010865A1223P0221X, 1223G0001X
VA04014117881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223P0221XDental ProvidersDentistPediatric Dentistry