Organization
CLARKSVILLE PEDIATRIC DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KARYL JEAN BEAUCHAMP DDS (PRESIDENT)
(931) 245-3333
Entity
Organization
Contact information
Practice address
2297 RUDOLPHTOWN RD, CLARKSVILLE, TN 37043-2226
(931) 245-3333
(931) 245-3334
Mailing address
2297 RUDOLPHTOWN RD, CLARKSVILLE, TN 37043-2226
(931) 245-3333
(931) 245-3334
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0160078
BLUE CROSS BLUE SHIELD OF TN
TN
01
—
112051
TENNCARE LOCATION NUMBER
TN
01
—
823192
UNITED CONCORDIA
TN
Enumeration date
06/07/2010
Last updated
06/08/2010
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