Organization
BEAVERS AND BROOMFIELD FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISTEN BEAVERS DDS (OWNER)
(479) 856-6610
Entity
Organization
Contact information
Practice address
2131 N CROSSOVER RD, SUITE101, FAYETTEVILLE, AR 72703-4333
(479) 856-6610
Mailing address
2131 N CROSSOVER RD, SUITE101, FAYETTEVILLE, AR 72703-4333
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3600
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168653631
—
AR
Enumeration date
08/28/2008
Last updated
08/28/2008
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