| Kokomo Pediatric Dentistry, Llc | |
|
2350 S Dixon Rd Ste 425 Kokomo IN 46902-6422 | |
| (765) 453-6000 | |
| Not Available |
| Full Name | Kokomo Pediatric Dentistry, Llc |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 2350 S Dixon Rd Ste 425, Kokomo, Indiana |
| Authorized Official Name and Position | Kevin Beadle (OWNER/DENTIST) |
| Authorized Official Contact | 3177092318 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kokomo Pediatric Dentistry, Llc 1314 Regal Dr Carmel IN 46032-9489 Ph: () - | Kokomo Pediatric Dentistry, Llc 2350 S Dixon Rd Ste 425 Kokomo IN 46902-6422 Ph: (765) 453-6000 |
| NPI Number | 1063904100 |
|---|---|
| Provider Enumeration Date | 06/05/2018 |
| Last Update Date | 06/05/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063904100 | NPI | - | NPPES |
| 200826740 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | 12010865A (Indiana) | Primary |
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