Provider Demographics
NPI:1801957113
Name:BEARD, STEPHEN T (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:T
Last Name:BEARD
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 1:509 SE DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-3636
Mailing Address - Country:US
Mailing Address - Phone:918-336-3441
Mailing Address - Fax:918-336-3446
Practice Address - Street 1:509 SE DELAWARE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-3636
Practice Address - Country:US
Practice Address - Phone:918-336-3441
Practice Address - Fax:918-336-3446
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice