Provider Demographics
NPI:1073264420
Name:BEACON DENTAL HEALTH MA II PLLC
Entity Type:Organization
Organization Name:BEACON DENTAL HEALTH MA II PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:
Authorized Official - First Name:HIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-344-5746
Mailing Address - Street 1:135 PINELAWN RD STE 150S
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3187
Mailing Address - Country:US
Mailing Address - Phone:631-414-7927
Mailing Address - Fax:631-396-0452
Practice Address - Street 1:59 COLUMBIAN ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2414
Practice Address - Country:US
Practice Address - Phone:781-337-6644
Practice Address - Fax:631-396-0452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty