MEDICARE: DR. KEITH M BEVER JR. DDS

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
1	122300000X	Dentist	18741	MI

General Provider Information

NPI Number	:	1619023017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH M BEVER JR. DDS

Provider Business Mailing Address
First Line	:	2325 HAWTHORN DRIVE
Second Line	:
City	:	MT. PLEASANT
State	:	MI
Zip	:	48858
Country	:	US
Telephone Number	:	989-773-9793
Fax Number	:	989-773-3063

Provider Business Practice Location Address
First Line	:	2325 HAWTHORN DRIVE
Second Line	:
City	:	MT. PLEASANT
State	:	MI
Zip	:	48858
Country	:	US
Telephone Number	:	989-773-9793
Fax Number	:	989-773-3063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	12/21/2017

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