Beaver Dental Associates, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

BEAVER DENTAL ASSOCIATES, LLC

Practice address

244 College Ave
Beaver, PA 15009-2706

Phone

(724) 774-1361

Fax

(724) 774-1932

NPI assigned

Jun 23, 2009

Last updated

Jun 23, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jacqueline A IngramNPI 1215178785

Title

Owner

Phone

(724) 774-1361

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jacqueline A Ingram

  • Dental Clinic/Center
  • Beaver, PA
  • NPI 1215178785
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245715200000",
    "number": "1205064771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 COLLEGE AVE",
            "city": "BEAVER",
            "state": "PA",
            "postal_code": "150092706",
            "telephone_number": "724-774-1361",
            "fax_number": "724-774-1932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 COLLEGE AVE",
            "city": "BEAVER",
            "state": "PA",
            "postal_code": "150092706",
            "telephone_number": "724-774-1361",
            "fax_number": "724-774-1932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVER DENTAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-23",
        "last_updated": "2009-06-23",
        "status": "A",
        "authorized_official_last_name": "INGRAM",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "724-774-1361",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Beaver, PA
• Providers in Beaver, PA by specialty
• Dental Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.