Provider Demographics
NPI:1619321734
Name:JACQUELINE M. BEARD, DMD, INC
Entity Type:Organization
Organization Name:JACQUELINE M. BEARD, DMD, INC
Other - Org Name:SOLON PEDIATRIC DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:PEDIATRIC DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:440-223-8767
Mailing Address - Street 1:35401 AURORA ROAD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3808
Mailing Address - Country:US
Mailing Address - Phone:440-528-1399
Mailing Address - Fax:
Practice Address - Street 1:34501 AURORA RD
Practice Address - Street 2:SUITE 305
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3873
Practice Address - Country:US
Practice Address - Phone:440-528-1399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023827261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0078308Medicaid
OH1063700789OtherINDIVIDUAL NPI