Provider Demographics
NPI: | 1285091363 |
---|---|
Name: | BEACON DENTAL HEALTH PC |
Entity type: | Organization |
Organization Name: | BEACON DENTAL HEALTH PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | FRANK |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | SCHIANO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DMD |
Authorized Official - Phone: | 617-418-6940 |
Mailing Address - Street 1: | 198 TREMONT ST |
Mailing Address - Street 2: | SUITE 436 |
Mailing Address - City: | BOSTON |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02116-4705 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 617-418-6940 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 249 STATION AVE |
Practice Address - Street 2: | |
Practice Address - City: | SOUTH YARMOUTH |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02664-1863 |
Practice Address - Country: | US |
Practice Address - Phone: | 617-418-6940 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | BEACON DENTAL HEALTH PC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2016-01-20 |
Last Update Date: | 2016-01-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | DN21699 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Multi-Specialty |