Provider Demographics
NPI:1326045519
Name:THURMOND, BEVERLY ANN (DDS)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:THURMOND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:THURMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS PLLC
Mailing Address - Street 1:7100 SIX FORKS RD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6156
Mailing Address - Country:US
Mailing Address - Phone:919-782-3798
Mailing Address - Fax:919-782-4459
Practice Address - Street 1:7100 SIX FORKS RD
Practice Address - Street 2:SUITE 235
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6156
Practice Address - Country:US
Practice Address - Phone:919-782-3798
Practice Address - Fax:919-782-4459
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2010-03-26
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2007-05-15
Provider Licenses
StateLicense IDTaxonomies
NC83531223G0001X
NM17861223G0001X
IDD30311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908719Medicaid
NM820454460Medicaid
NC903KGOtherBCBS NC