Ollie Logan Beard IV, DDS
Individual provider Active NPI Dentist · Tishomingo, OK
NPI 1992233779 · NPPES record last updated May 24, 2017
Key facts
- NPI
- 1992233779
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 6918 (OK)
- Practice address
- 610 E 24TH St
Tishomingo, OK 73460-3245 - Phone
- (580) 371-2343
- Fax
- (580) 371-2451
- NPI assigned
- May 24, 2017
- 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 |
|---|---|---|---|
| 6918 | OK | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6918 | OK | Yes |
Addresses
Primary practice location
610 E 24TH St
Tishomingo, OK 73460-3245
Mailing address
PO Box 128
Madill, OK 73446-0128
Phone (580) 795-6664
Other providers in Tishomingo, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 24, 2017. 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.