Healthcare Provider Details

I. General information

NPI: 1861344780
Provider Name (Legal Business Name): BEAVER FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 DABNEYS MILL RD
MANQUIN VA
23106-2508
US

IV. Provider business mailing address

41 DABNEYS MILL RD
MANQUIN VA
23106-2508
US

V. Phone/Fax

Practice location:
  • Phone: 804-769-3005
  • Fax:
Mailing address:
  • Phone: 804-769-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHWETA THACKERAY
Title or Position: DENTAL DIRECTOR
Credential: DDS
Phone: 817-600-4560