Provider Demographics
NPI:1376870154
Name:BEVERLY, DAVID T (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:BEVERLY
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 BEAL PKWY SW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5331
Mailing Address - Country:US
Mailing Address - Phone:850-862-6666
Mailing Address - Fax:850-862-7707
Practice Address - Street 1:82 BEAL PKWY SW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5331
Practice Address - Country:US
Practice Address - Phone:850-862-6666
Practice Address - Fax:850-862-7707
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67261223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics