Provider Demographics
NPI:1326106428
Name:BEAVERS, DANIEL J (DDS,PA)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:BEAVERS
Suffix:
Gender:M
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:105 WEST PARK STREET
Mailing Address - City:LINCOLN
Mailing Address - State:AR
Mailing Address - Zip Code:72744-0488
Mailing Address - Country:US
Mailing Address - Phone:479-824-3247
Mailing Address - Fax:479-824-3100
Practice Address - Street 1:105 WEST PARK AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:AR
Practice Address - Zip Code:72744-0488
Practice Address - Country:US
Practice Address - Phone:479-824-3247
Practice Address - Fax:479-824-3100
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR23781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice