Provider Demographics
NPI:1144370107
Name:BEAVERS, PAUL E (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
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 1:619 W CHATHAM ST
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-1415
Mailing Address - Country:US
Mailing Address - Phone:919-362-0967
Mailing Address - Fax:919-355-1551
Practice Address - Street 1:619 W CHATHAM ST
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1415
Practice Address - Country:US
Practice Address - Phone:919-362-0967
Practice Address - Fax:919-355-1551
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990552Medicaid