Provider Demographics
NPI:1528082682
Name:BEAUCHAMP, KARYL JEAN (DDS)
Entity type:Individual
Prefix:
First Name:KARYL
Middle Name:JEAN
Last Name:BEAUCHAMP
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 1:2297 RUDOLPHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:931-245-3333
Mailing Address - Fax:931-245-3334
Practice Address - Street 1:2297 RUDOLPHTOWN RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-245-3333
Practice Address - Fax:931-245-3334
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN823192OtherUNITED CONCORDIA PROVIDER
TN6121OtherTENNCARE PROV. LOCATION
TN00160078OtherBCBS OF TN PROVIDER NUMBE