MEDICARE: BEAM ENDODONTICS

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	1223E0200X	Endodontics	7144	SC

General Provider Information

NPI Number	:	1922431600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAM ENDODONTICS

Provider Business Mailing Address
First Line	:	936 MARKET ST
Second Line	:	SUITE 206
City	:	FORT MILL
State	:	SC
Zip	:	29708-6562
Country	:	US
Telephone Number	:	803-548-4400
Fax Number	:	803-548-4414

Provider Business Practice Location Address
First Line	:	936 MARKET ST
Second Line	:	SUITE 206
City	:	FORT MILL
State	:	SC
Zip	:	29708-6562
Country	:	US
Telephone Number	:	803-548-4400
Fax Number	:	803-548-4414

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NATHAN EDWARD BEAM
Credential	:	D.D.S., M.S.
Telephone Number	:	83-548-4400

Provider Enumeration Date	:	08/16/2013
Last Update Date	:	08/16/2013

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