Provider Demographics
NPI:1215104534
Name:BEAUDIN, JENNIFER LYNN (DMD, MSED)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:BEAUDIN
Suffix:
Gender:F
Credentials:DMD, MSED
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6112 MERLIN CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-7358
Mailing Address - Country:US
Mailing Address - Phone:989-839-9979
Mailing Address - Fax:989-839-9553
Practice Address - Street 1:6112 MERLIN CT
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-7358
Practice Address - Country:US
Practice Address - Phone:989-839-9979
Practice Address - Fax:989-839-9553
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010213761223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery