Provider Demographics
NPI:1134165335
Name:BEAVERS, JAMES VERL (DDS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:VERL
Last Name:BEAVERS
Suffix:
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 1:354 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-7059
Mailing Address - Country:US
Mailing Address - Phone:501-745-7711
Mailing Address - Fax:501-745-5095
Practice Address - Street 1:354 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-7059
Practice Address - Country:US
Practice Address - Phone:501-745-7711
Practice Address - Fax:501-745-5095
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR710860830OtherTAX NUMBER