Provider Demographics
NPI:1942756721
Name:BEAL, KAYLA ANNE (IPDH)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:ANNE
Last Name:BEAL
Suffix:
Gender:F
Credentials:IPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:MILBRIDGE
Mailing Address - State:ME
Mailing Address - Zip Code:04658-0328
Mailing Address - Country:US
Mailing Address - Phone:207-598-6195
Mailing Address - Fax:207-422-6525
Practice Address - Street 1:19 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MILBRIDGE
Practice Address - State:ME
Practice Address - Zip Code:04658
Practice Address - Country:US
Practice Address - Phone:207-598-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH4012124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist