Provider Demographics
NPI:1194173955
Name:BEAM, KATI IRENE (DDS)
Entity type:Individual
Prefix:DR
First Name:KATI
Middle Name:IRENE
Last Name:BEAM
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 1:2222 N GREENWICH RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-8252
Mailing Address - Country:US
Mailing Address - Phone:316-252-3139
Mailing Address - Fax:316-221-7958
Practice Address - Street 1:2222 N GREENWICH RD STE 400
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8252
Practice Address - Country:US
Practice Address - Phone:316-252-3139
Practice Address - Fax:316-221-7958
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS611551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice