Provider Demographics
NPI:1740402924
Name:BEARD, CARL B (DMD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:B
Last Name:BEARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2962 RICHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1413
Mailing Address - Country:US
Mailing Address - Phone:502-454-3621
Mailing Address - Fax:502-454-3622
Practice Address - Street 1:2962 RICHLAND AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1413
Practice Address - Country:US
Practice Address - Phone:502-454-3621
Practice Address - Fax:502-454-3622
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY72631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice