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Organization
KOKOMO PEDIATRIC DENTISTRY, LLC
Active
Organization
KOKOMO PEDIATRIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BEADLE DDS (OWNER/DENTIST)
(317) 709-2318
Entity
Organization
Contact information
Practice address
2350 S DIXON RD STE 425, KOKOMO, IN 46902-6422
(765) 453-6000
Mailing address
1314 REGAL DR, CARMEL, IN 46032-9489
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
12010865A
IN
Other
Enumeration date
06/05/2018
Last updated
06/05/2018
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