Provider Demographics
NPI:1679665871
Name:BEAVERS, TYREL TIMOTHY (DMD)
Entity Type:Individual
Prefix:MR
First Name:TYREL
Middle Name:TIMOTHY
Last Name:BEAVERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 N. POWER RD #2
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205
Mailing Address - Country:US
Mailing Address - Phone:480-832-4567
Mailing Address - Fax:480-854-3869
Practice Address - Street 1:1259 N. POWER RD #2
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205
Practice Address - Country:US
Practice Address - Phone:480-832-4567
Practice Address - Fax:480-854-3869
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice