Provider Demographics
NPI:1881261469
Name:JOSHUA BEAVER DDS LLC
Entity type:Organization
Organization Name:JOSHUA BEAVER DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DON
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-324-5077
Mailing Address - Street 1:104 S SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-4136
Mailing Address - Country:US
Mailing Address - Phone:985-549-0794
Mailing Address - Fax:
Practice Address - Street 1:104 S SPRUCE ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-4136
Practice Address - Country:US
Practice Address - Phone:985-549-0794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1859141Medicaid