Individual
DR. CHARLES RUNNELS BEAVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6050 S MAY AVE, OKLAHOMA CITY, OK 73159-1402
(405) 682-9557
Mailing address
6050 S MAY AVE, OKLAHOMA CITY, OK 73159-1402
(405) 682-9557
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4453
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4453
STATE DENTAL LICENSE
OK
Enumeration date
06/08/2006
Last updated
07/08/2007
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