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DR. NATHAN KEIL BEAVERS D.M.D.

Pediatric Dentistry

Madison, Mississippi

Provider NPI: 1790849404

Provider Information:
DR. NATHAN KEIL BEAVERS D.M.D.
Gender: M
Not Sole Proprietor

Practice Location:
119 COLONY CROSSING WAY SUITE 740 MADISON, MS 39110 US
Tel: 601-856-5313  Fax: 601-856-5552

Business Mailing Address:
119 COLONY CROSSING WAY SUITE 740 MADISON, MS 39110 US
Tel: 601-856-5313  Fax: 601-856-5552

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223P0221XDental Providers
Dentist
Pediatric Dentistry
MSPEDO 377-04

Other Provider Identifiers:

IssuerNumberStateType
08101262MS05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin



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