Provider Demographics
NPI:1134727027
Name:BEARD, KATHERINE VIVIAN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:VIVIAN
Last Name:BEARD
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2173
Mailing Address - Country:US
Mailing Address - Phone:616-842-8820
Mailing Address - Fax:616-842-8822
Practice Address - Street 1:600 PARK AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2173
Practice Address - Country:US
Practice Address - Phone:616-842-8820
Practice Address - Fax:616-842-8822
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016003941223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics