Individual
DR. BEAU JOHN BRASSEALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.D.
Contact information
Practice address
901 WILKINSON TRCE, SUITE #2, BOWLING GREEN, KY 42103-2483
(270) 904-4404
Mailing address
901 WILKINSON TRCE, SUITE #2, BOWLING GREEN, KY 42103-2483
(270) 904-4404
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
9102
KY
1223G0001X
General Practice Dentistry
12011193A
IN
Other
Enumeration date
07/01/2008
Last updated
10/14/2011
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