Provider Demographics
NPI:1063700789
Name:BEARD, JACQUELINE MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:MARIE
Last Name:BEARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:MARIE
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5525 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3156
Mailing Address - Country:US
Mailing Address - Phone:216-663-1967
Mailing Address - Fax:216-663-1819
Practice Address - Street 1:5525 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3156
Practice Address - Country:US
Practice Address - Phone:216-663-1967
Practice Address - Fax:216-663-1819
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.3066122300000X
OH300238271223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist