Provider Demographics
NPI:1447473061
Name:DORRANCE, BEVERLY H (DMD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:H
Last Name:DORRANCE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LONG RUN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4363
Mailing Address - Country:US
Mailing Address - Phone:502-244-1006
Mailing Address - Fax:
Practice Address - Street 1:7420 WESTPORT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4106
Practice Address - Country:US
Practice Address - Phone:502-412-3444
Practice Address - Fax:502-412-3424
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7325122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist