Provider Demographics
NPI:1588710826
Name:BEADLING, KENNETH W JR (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:W
Last Name:BEADLING
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1850 WHITES RD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-4801
Mailing Address - Country:US
Mailing Address - Phone:269-381-2587
Mailing Address - Fax:269-381-1060
Practice Address - Street 1:1850 WHITES RD
Practice Address - Street 2:SUITE #4
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-4801
Practice Address - Country:US
Practice Address - Phone:269-381-2587
Practice Address - Fax:269-381-1060
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI14276122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist