Provider Demographics
NPI:1619023017
Name:BEVER, KEITH M JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:M
Last Name:BEVER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 HAWTHORN DRIVE
Mailing Address - Street 2:
Mailing Address - City:MT. PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-773-9793
Mailing Address - Fax:989-773-3063
Practice Address - Street 1:2325 HAWTHORN DRIVE
Practice Address - Street 2:
Practice Address - City:MT. PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-773-9793
Practice Address - Fax:989-773-3063
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist