Individual
AVERY BROOKE BEARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
13121 E 21ST ST N STE 107, WICHITA, KS 67230-7403
(316) 630-9500
Mailing address
13121 E 21ST ST N STE 107, WICHITA, KS 67230-7403
(316) 630-9500
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
62661
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62661
DENTAL LICENSE
KS
Enumeration date
06/26/2019
Last updated
06/26/2019
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