Individual
DR. KATHLEEN A BEAUDRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D., M.S.
Contact information
Practice address
1919 7TH AVE S, 412 SCHOOL OF DENTISTRY BUILDING, BIRMINGHAM, AL 35233-2005
(205) 934-4551
Mailing address
813 N STILSON RD, SUITE C, BOISE, ID 83703-5119
(208) 344-0908
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
5817
AL
122300000X
Dentist
DE60121655
WA
1223P0300X
Periodontics
Primary
D444PE
ID
Other
Enumeration date
03/29/2011
Last updated
04/10/2013
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