Provider Demographics
NPI:1497747166
Name:BEARD, OLLIE LOGAN III (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLLIE
Middle Name:LOGAN
Last Name:BEARD
Suffix:III
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:PO BOX 128
Mailing Address - Street 2:301 WEST LILLIE BLVD
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446-0128
Mailing Address - Country:US
Mailing Address - Phone:580-920-2292
Mailing Address - Fax:580-795-5273
Practice Address - Street 1:301 W LILLIE BLVD
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-1253
Practice Address - Country:US
Practice Address - Phone:580-795-5400
Practice Address - Fax:580-795-5723
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist