Provider Demographics
NPI:1922431600
Name:BEAM ENDODONTICS
Entity Type:Organization
Organization Name:BEAM ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BEAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:083-548-4400
Mailing Address - Street 1:936 MARKET ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6562
Mailing Address - Country:US
Mailing Address - Phone:803-548-4400
Mailing Address - Fax:803-548-4414
Practice Address - Street 1:936 MARKET ST
Practice Address - Street 2:SUITE 206
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6562
Practice Address - Country:US
Practice Address - Phone:803-548-4400
Practice Address - Fax:803-548-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC71441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty