Provider Demographics
NPI:1194208280
Name:BEAUDOIN, DANIELLE ALICIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:ALICIA
Last Name:BEAUDOIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20335 OLD CUTLER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1800
Mailing Address - Country:US
Mailing Address - Phone:786-604-0294
Mailing Address - Fax:
Practice Address - Street 1:20335 OLD CUTLER RD STE 200
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1800
Practice Address - Country:US
Practice Address - Phone:866-040-2947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6926122300000X, 1223P0221X
FLDN286701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist