Provider Demographics
NPI:1740898584
Name:JAMIE BEAVERS DDS, P.A.
Entity type:Organization
Organization Name:JAMIE BEAVERS DDS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:VERL
Authorized Official - Last Name:BEAVERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-253-0648
Mailing Address - Street 1:354 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031
Mailing Address - Country:US
Mailing Address - Phone:501-253-0648
Mailing Address - Fax:
Practice Address - Street 1:354 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031
Practice Address - Country:US
Practice Address - Phone:501-253-0648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty