Provider Demographics
NPI:1700621703
Name:BECHARD, KIANNA RAE (DDS)
Entity type:Individual
Prefix:
First Name:KIANNA
Middle Name:RAE
Last Name:BECHARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KIANNA
Other - Middle Name:RAE
Other - Last Name:HREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4291 HEARTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1690
Mailing Address - Country:US
Mailing Address - Phone:218-349-1234
Mailing Address - Fax:
Practice Address - Street 1:1624 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-2628
Practice Address - Country:US
Practice Address - Phone:218-464-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND151261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice