Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 30023827 | OH |
N | 122300000X | Dentist | RES.3066 | OH |
Y | 1223P0221X | Pediatric Dentist | 30023827 | OH |
NPI | 1063700789 |
---|---|
Provider Name | Dr. Jacqueline Marie Beard |
First Address | Maple Heights, OH 44137-3156 |
Second Address | Maple Heights, OH 44137-3156 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2011 |
Last Update Date | 27/08/2013 |