Individual
KENNETH C BEAL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
913 B.B. KING ROAD, INDIANOLA, MS 38751
(662) 887-4814
(662) 887-9418
Mailing address
PO BOX 1077, INDIANOLA, MS 38751-1077
(662) 887-4814
(662) 887-9418
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2459-89
MS
Other
Enumeration date
08/21/2007
Last updated
08/21/2007
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