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General NPI Number Information
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NPI Number | 1689964892
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Entity Type | Individual
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Provider Name | CHARLES MACDONALD BEAVERS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/10/2011
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 2600 OAKCREST AVE STE B
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City | GREENSBORO
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State | NC
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Zip | 27408-1935
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Country | US
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Telephone | 336-282-9886
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Fax | 336-282-9780
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Provider Business Mailing Address
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Address Line | 2600 OAKCREST AVE STE B
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City | GREENSBORO
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State | NC
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Zip | 27408-1935
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Country | US
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Telephone | 336-282-9886
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Fax | 336-282-9780
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 09835
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License Number State | NC
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