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General NPI Number Information
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NPI Number | 1376870154
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Entity Type | Individual
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Provider Name | DAVID T BEVERLY D.M.D, M.S.D
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Gender | Male
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 11/16/2009
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Provider Practice Location Address
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Address Line | 82 BEAL PKWY SW
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5331
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Country | US
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Telephone | 850-862-6666
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Fax | 850-862-7707
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Provider Business Mailing Address
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Address Line | 82 BEAL PKWY SW
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5331
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Country | US
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Telephone | 850-862-6666
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Fax | 850-862-7707
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 6726
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License Number State | FL
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