Provider Demographics
NPI:1538144183
Name:BEARDSLEY, JOHN PHILIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PHILIP
Last Name:BEARDSLEY
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:PO BOX 1148
Mailing Address - Street 2:213 3RD AVE N
Mailing Address - City:LAKEFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:56150-1148
Mailing Address - Country:US
Mailing Address - Phone:507-662-5358
Mailing Address - Fax:
Practice Address - Street 1:213 3RD AVE N
Practice Address - Street 2:
Practice Address - City:LAKEFIELD
Practice Address - State:MN
Practice Address - Zip Code:56150-1123
Practice Address - Country:US
Practice Address - Phone:507-662-5358
Practice Address - Fax:507-662-5108
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist