Provider Demographics
NPI:1063564862
Name:BECK-BAIR, KRISTY L (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:L
Last Name:BECK-BAIR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:DIMONDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48821-0448
Mailing Address - Country:US
Mailing Address - Phone:517-646-8226
Mailing Address - Fax:517-646-7545
Practice Address - Street 1:214 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:DIMONDALE
Practice Address - State:MI
Practice Address - Zip Code:48821-8702
Practice Address - Country:US
Practice Address - Phone:517-646-8226
Practice Address - Fax:517-646-7545
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1438201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice