Provider Demographics
NPI:1235342452
Name:JAY A. BEAUCHEMIN, DDS, PA
Entity Type:Organization
Organization Name:JAY A. BEAUCHEMIN, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEAUCHEMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-284-4007
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:SUITE 1218
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3509
Mailing Address - Country:US
Mailing Address - Phone:207-284-4007
Mailing Address - Fax:
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:SUITE 1218
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3509
Practice Address - Country:US
Practice Address - Phone:207-284-4007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3159261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental