Provider Demographics
NPI:1124041413
Name:BEAVERS, GARY W
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:W
Last Name:BEAVERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 HIGH HOUSE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4278
Mailing Address - Country:US
Mailing Address - Phone:919-467-7717
Mailing Address - Fax:
Practice Address - Street 1:224 HIGH HOUSE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-4278
Practice Address - Country:US
Practice Address - Phone:919-467-7717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice