Individual
DR. NATHAN KEIL BEAVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
312 FOUNTAINS DR, MADISON, MS 39110-6384
(601) 856-5313
(601) 856-5552
Mailing address
312 FOUNTAINS DR, MADISON, MS 39110-6384
(601) 856-5313
(601) 856-5552
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
PEDO-377-04
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08101262
—
MS
Enumeration date
12/20/2006
Last updated
10/07/2025
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