| Organization Name: | NATHAN K. BEAVERS DMD PLLC |
| NPI Number: | 1003138967 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NATHAN BEAVERS (MANAGING PARTNER) |
| Mailing Address: | 119 Colony Crossing Way Suite 740 Madison |
| State: | MS US |
| Postal Code: | 391106322 |
| Phone Number: | 6018565313 |
| Fax Number: | |
| NPI Enumeration Date: | 02/19/2010 |
| NPI Last Update Date: | 02/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | PEDO 377-04 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |