Provider Demographics
NPI:1609140862
Name:BEAUMONT DENTAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:BEAUMONT DENTAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/TREASURER AND SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:H
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:859-223-0011
Mailing Address - Street 1:3181 BEAUMONT CENTRE CIR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1836
Mailing Address - Country:US
Mailing Address - Phone:859-223-0011
Mailing Address - Fax:
Practice Address - Street 1:3181 BEAUMONT CENTRE CIR
Practice Address - Street 2:SUITE 114
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1836
Practice Address - Country:US
Practice Address - Phone:859-223-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8193122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty