Provider Demographics
NPI:1841174687
Name:BEAVER, SOPHIA MARIE (DMD)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:MARIE
Last Name:BEAVER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25312 N 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8603
Mailing Address - Country:US
Mailing Address - Phone:321-298-7668
Mailing Address - Fax:
Practice Address - Street 1:5144 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-4209
Practice Address - Country:US
Practice Address - Phone:623-939-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD012616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist