Provider Demographics
NPI:1962552976
Name:BEAVERS AND BEAVERS D.D.S., P.A.
Entity type:Organization
Organization Name:BEAVERS AND BEAVERS D.D.S., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-362-0967
Mailing Address - Street 1:619 W CHATHAM ST
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-1415
Mailing Address - Country:US
Mailing Address - Phone:919-362-0967
Mailing Address - Fax:919-355-1551
Practice Address - Street 1:619 W CHATHAM ST
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1415
Practice Address - Country:US
Practice Address - Phone:919-362-0967
Practice Address - Fax:919-355-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015X2Medicaid