Individual
DR. KATHLEEN JUDITH BEACHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
7225 US 31 S STE G, INDIANAPOLIS, IN 46227-8599
(317) 496-6652
Mailing address
6510 FALL CREEK RD, INDIANAPOLIS, IN 46220-5087
(317) 259-9426
(317) 259-9426
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009653A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12009653A
INDIANA PROFESSIONAL LICENSING AGENCY
IN
05
—
200097410
—
IN
Enumeration date
04/13/2007
Last updated
09/10/2019
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