# KOKOMO PEDIATRIC DENTISTRY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063904100
- **Authorized official:** KEVIN BEADLE DDS (OWNER/DENTIST)
- **Authorized official phone:** (317) 709-2318

## Contact information

- **Practice address:** 2350 S DIXON RD STE 425, KOKOMO, IN 46902-6422
- **Practice address phone:** (765) 453-6000
- **Mailing address:** 1314 REGAL DR, CARMEL, IN 46032-9489

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223D0001X | Public Health Dentistry | 12010865A | IN | Yes |

## Other

- **Enumeration date:** 06/05/2018
- **Last updated:** 06/05/2018