Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 4609 | NC |
NPI | 1124179098 |
---|---|
Provider Name | Dr. Richard Allen Beavers |
First Address | Greensboro, NC 27408-1935 |
Second Address | Greensboro, NC 27408-1935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |