Provider Demographics
NPI:1407097660
Name:BEVER, KEITH MARTIN SR (DDS MS)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:MARTIN
Last Name:BEVER
Suffix:SR
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1085
Mailing Address - Country:US
Mailing Address - Phone:989-463-2400
Mailing Address - Fax:989-463-2726
Practice Address - Street 1:317 E WARWICK DR
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1085
Practice Address - Country:US
Practice Address - Phone:989-463-2400
Practice Address - Fax:989-463-2726
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI95241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics