Provider Demographics
NPI:1558737213
Name:H. A. BEAVER, III DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:H. A. BEAVER, III DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRION
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-396-4746
Mailing Address - Street 1:1677 ART MUSEUM DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207
Mailing Address - Country:US
Mailing Address - Phone:904-396-4746
Mailing Address - Fax:904-396-4924
Practice Address - Street 1:1677 ART MUSEUM DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207
Practice Address - Country:US
Practice Address - Phone:904-396-4746
Practice Address - Fax:904-396-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty