Provider Demographics
NPI:1518576032
Name:K-BEACH DENTAL GROUP
Entity Type:Organization
Organization Name:K-BEACH DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGHANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PENLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-283-9210
Mailing Address - Street 1:36892 MALLARD RD
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-6434
Mailing Address - Country:US
Mailing Address - Phone:907-283-9210
Mailing Address - Fax:907-283-3184
Practice Address - Street 1:36892 MALLARD RD
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-6434
Practice Address - Country:US
Practice Address - Phone:907-283-9210
Practice Address - Fax:907-283-3184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental