Provider Demographics
NPI:1295097160
Name:BEAIRD, JARED HUNTER (DDS)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:HUNTER
Last Name:BEAIRD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 LURLYN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2763
Mailing Address - Country:US
Mailing Address - Phone:573-778-0200
Mailing Address - Fax:573-778-0214
Practice Address - Street 1:1611 LURLYN DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901
Practice Address - Country:US
Practice Address - Phone:573-778-0200
Practice Address - Fax:573-778-0214
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0182211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice