Provider Demographics
NPI:1942946801
Name:BEEDY-STORTS, KERRI DANIELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KERRI
Middle Name:DANIELLE
Last Name:BEEDY-STORTS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:DANIELLE
Other - Last Name:BEEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2825 BROADVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-3405
Mailing Address - Country:US
Mailing Address - Phone:937-207-4328
Mailing Address - Fax:
Practice Address - Street 1:2825 BROADVIEW DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-3405
Practice Address - Country:US
Practice Address - Phone:937-207-4328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist