# BRANDON E BEAVER DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Westside Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174741474
- **Authorized official:** TIFFANY L LANGLEY (OFFICE MANAGER)
- **Authorized official phone:** (580) 924-1234

## Contact information

- **Practice address:** 2915 WESTSIDE DRIVE, DURANT, OK 74701-2028
- **Practice address phone:** (580) 924-1234
- **Practice address fax:** (580) 920-2082
- **Mailing address:** 2915 WESTSIDE DRIVE, DURANT, OK 74701-2028
- **Mailing address phone:** (580) 924-1234
- **Mailing address fax:** (580) 920-2082

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 3469 | OK | — |
| 122300000X | Dentist | 5597 | OK | Yes |

## Other

- **Enumeration date:** 04/23/2007
- **Last updated:** 06/16/2015