Beau Lyndon Broussard, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12203 Issued in TN

Practice address

2623 Highway 70 E
Crossville, TN 38555-2808

Phone

(931) 484-9495

NPI assigned

Jun 27, 2023

Last updated

Jun 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tennessee Dental Professionals, PC

  dba Dental Care of Crossville

  • General Practice Dentistry
  • Crossville, TN
  • NPI 1548833601
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1720764442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2623 HIGHWAY 70 E",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385552808",
            "telephone_number": "931-484-9495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2623 HIGHWAY 70 E",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385552808",
            "telephone_number": "931-484-9495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "BEAU",
        "middle_name": "LYNDON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-27",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "12203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janie Ruth Bristol, R.N
• James Cecil Bristow
• Philip M Brock, OD
• Tim Ray Brockett
• Jessica Brooks
• Angela Lynn Brown, FNP-BC
• Barry J Brown, M.D.
• Bobbie Jean Brown, MLT
• Leslie Brown, DPT
• Linda Brown, RDN

• General Practice Dentistry in Crossville, TN
• Providers in Crossville, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.