Provider Demographics
NPI:1871621995
Name:BEARD, CHARLES CLIFFORD (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CLIFFORD
Last Name:BEARD
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:CLIFFORD
Other - Last Name:BEARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS,MS
Mailing Address - Street 1:9576 WHISPERING PINES DR
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-9042
Mailing Address - Country:US
Mailing Address - Phone:734-429-1414
Mailing Address - Fax:
Practice Address - Street 1:625 E LIBERTY ST
Practice Address - Street 2:SUITE 205
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2013
Practice Address - Country:US
Practice Address - Phone:734-668-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010122341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice