# BEAVER DENTAL ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205064771
- **Authorized official:** MRS. JACQUELINE A INGRAM (OWNER)
- **Authorized official phone:** (724) 774-1361

## Contact information

- **Practice address:** 244 COLLEGE AVE, BEAVER, PA 15009-2706
- **Practice address phone:** (724) 774-1361
- **Practice address fax:** (724) 774-1932
- **Mailing address:** 244 COLLEGE AVE, BEAVER, PA 15009-2706
- **Mailing address phone:** (724) 774-1361
- **Mailing address fax:** (724) 774-1932

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/23/2009
- **Last updated:** 06/23/2009