| Nathan K. Beavers Dmd Pllc | |
|
312 Fountains Drive Madison MS 39110 | |
| (601) 856-5313 | |
| Not Available |
| Full Name | Nathan K. Beavers Dmd Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 312 Fountains Drive, Madison, Mississippi |
| Authorized Official Name and Position | Nathan Beavers (OWNER / DENTIST) |
| Authorized Official Contact | 6018565313 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nathan K. Beavers Dmd Pllc 119 Colony Crossing Way Suite 740 Madison MS 39110-6322 Ph: (601) 856-5313 | Nathan K. Beavers Dmd Pllc 312 Fountains Drive Madison MS 39110 Ph: (601) 856-5313 |
| NPI Number | 1003138967 |
|---|---|
| Provider Enumeration Date | 02/19/2010 |
| Last Update Date | 10/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003138967 | NPI | - | NPPES |
| 05382775 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | PEDO 377-04 (Mississippi) | Primary |
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