Provider Demographics
NPI:1104054550
Name:BEAM, NATHAN EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:EDWARD
Last Name:BEAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 MARKET ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6562
Mailing Address - Country:US
Mailing Address - Phone:803-548-4400
Mailing Address - Fax:803-548-4414
Practice Address - Street 1:936 MARKET ST
Practice Address - Street 2:SUITE 206
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6562
Practice Address - Country:US
Practice Address - Phone:803-548-4400
Practice Address - Fax:803-548-4414
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3875122300000X
SC71441223E0200X
NC91901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist