Individual
DR. KELLY BEAMISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
191 MAIN ST STE 1, OLD SAYBROOK, CT 06475-2392
(555) 555-5555
Mailing address
191 MAIN ST STE 1, OLD SAYBROOK, CT 06475-2392
(555) 555-5555
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11598
CT
Other
Enumeration date
06/11/2015
Last updated
07/24/2016
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