Provider Demographics
NPI:1700946647
Name:LARGENT, BEVERLY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:A
Last Name:LARGENT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-5651
Mailing Address - Country:US
Mailing Address - Phone:270-554-5437
Mailing Address - Fax:270-554-5236
Practice Address - Street 1:3008 OREGON ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-5651
Practice Address - Country:US
Practice Address - Phone:270-554-5437
Practice Address - Fax:270-554-5236
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY54661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60054665Medicaid