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Contact Information

KOKOMO PEDIATRIC DENTISTRY, LLC
2350 S DIXON RD STE 425
KOKOMO, IN46902-6422
 Phone: 765-453-6000
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dental Public Health

1223D0001X
Indicates primary specialty

NPI Profile & details for KOKOMO PEDIATRIC DENTISTRY, LLC

NPI Number 1063904100
LBN Legal business name KOKOMO PEDIATRIC DENTISTRY, LLC
Authorized official KEVIN BEADLE - (OWNER/DENTIST)
Entity Organization
Organization subpart 1 No
Enumeration date 06/05/2018
Last updated 06/05/2018 - About 8 years ago
Identifiers
IN License # 12010865A
IN Medicaid 200826740
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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