Benjamin Beachy, DMD
Individual provider Active NPI Dentist · Fort Campbell, KY
NPI 1124856554 · NPPES record last updated Jul 25, 2024
Key facts
- NPI
- 1124856554
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 11180 (KY)
- Practice address
- 5580 Desert Storm Ave
Fort Campbell, KY 42223-5586 - Phone
- (270) 798-6362
- NPI assigned
- Jul 25, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11180 | KY | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11180 | KY | Yes |
Addresses
Primary practice location
5580 Desert Storm Ave
Fort Campbell, KY 42223-5586
Mailing address
496 Ayden LN
Clarksville, TN 37042-2887
Phone (937) 613-6030
Other providers in Fort Campbell, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.