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General NPI Number Information
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NPI Number | 1003138967
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Entity Type | Organization
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Legal Business Name | NATHAN K. BEAVERS DMD PLLC
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Dates
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Enumeration Date | 02/19/2010
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 312 FOUNTAINS DR
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City | MADISON
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State | MS
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Zip | 39110-6384
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Country | US
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Telephone | 601-856-5313
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Fax | 601-856-5552
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Provider Business Mailing Address
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Address Line | 312 FOUNTAINS DR
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City | MADISON
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State | MS
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Zip | 39110-6384
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Country | US
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Telephone | 601-856-5313
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Fax | 601-856-5552
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Authorized Official
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Title or Position | DENTIST
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Name | ANNE MARIE CURRIE HREISH
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Credential | DDS
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Telephone | 601-856-5313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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