IndividualActive
Beau Broussard, DMD
NPI 1720764442 · General Practice Dentistry · Crossville, TN
Provider details
- NPI number
- 1720764442
- Entity type
- Individual
- Primary specialty
- General Practice DentistryDental Providers
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- No
- License
- 12203 (TN)
Specialties & taxonomies
Dental Providers
Practice location
2623 Highway 70 E
Crossville, TN 38555-2808
Phone: (931) 484-9495
Approximate (ZIP-level) locationGet directions
Mailing address
2623 Highway 70 E
Crossville, TN 38555-2808
Registry dates
- Enumerated
- 2023-06-27
- Last updated
- 2023-06-27
- Certified
- 2023-06-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.