Provider Demographics
NPI:1427016781
Name:BEVERLY A THURMOND
Entity Type:Organization
Organization Name:BEVERLY A THURMOND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THURMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-526-0888
Mailing Address - Street 1:2990 N MAIN ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1195
Mailing Address - Country:US
Mailing Address - Phone:505-526-0888
Mailing Address - Fax:505-526-9775
Practice Address - Street 1:2990 N MAIN ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1195
Practice Address - Country:US
Practice Address - Phone:505-526-0888
Practice Address - Fax:505-526-9775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD17861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM=========OtherEIN