# DR. KATHLEEN JUDITH BEACHE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1154546489
- **Gender:** F
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12009653A | IN | Yes |

## Other

- **Enumeration date:** 04/13/2007
- **Last updated:** 09/10/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 12009653A | INDIANA PROFESSIONAL LICENSING AGENCY | IN |
| 05 | — | 200097410 | — | IN |