Provider Demographics
NPI:1023251972
Name:BARNES & BEAVERS FAMILY DENTISTRY INC.
Entity type:Organization
Organization Name:BARNES & BEAVERS FAMILY DENTISTRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES BEAVERS
Authorized Official - Middle Name:RUNNELS
Authorized Official - Last Name:BEAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-682-9557
Mailing Address - Street 1:6050 S MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-1402
Mailing Address - Country:US
Mailing Address - Phone:405-682-9557
Mailing Address - Fax:
Practice Address - Street 1:6050 S MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-1402
Practice Address - Country:US
Practice Address - Phone:405-682-9557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty