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NPI Code Detail

MEDICARE: DR. GARY W BEAVERS

MEDICARE: DR. GARY W BEAVERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry5264NC

General Provider Information

NPI Number : 1124041413
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY W BEAVERS
Provider Business Mailing Address
First Line : 224 HIGH HOUSE ROAD
Second Line : SUITE 200
City : CARY
State : NC
Zip : 27513-4278
Country : US
Telephone Number : 919-467-7717
Fax Number :
Provider Business Practice Location Address
First Line : 224 HIGH HOUSE RD
Second Line : SUITE 200
City : CARY
State : NC
Zip : 27513-4278
Country : US
Telephone Number : 919-467-7717
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 11/25/2015

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