Provider Demographics
NPI:1235441932
Name:BEAVER, JOSHUA DON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DON
Last Name:BEAVER
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 1:1801 CM FAGAN DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5849
Mailing Address - Country:US
Mailing Address - Phone:225-324-5507
Mailing Address - Fax:
Practice Address - Street 1:1801 CM FAGAN DR
Practice Address - Street 2:SUITE 5
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5849
Practice Address - Country:US
Practice Address - Phone:225-324-5507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59141223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics